altace no longer working + pain in lower back

[evelyn1]

I've taken various bp meds, cardizem, maxide, toprol, & diovan, none too effective. last march I started altace, and bp was good, quite low, until august, then it started creeping back up. now it's running 117/85 to 140/98. yikes. I only take 2.5 mg, sometimes I add another 2.5 for a total of 5 a day.

also i occasionally have an odd little twinge in right lower back, maybe where kidneys are, but seems to be nothing. but could it be related?

should I just up the altace dosage; i've read on this site that many people develop a resistance to ACEIs after 6 months.

thanks.

[Lenin]

Since you've been on a a diuretic, a beta-blocker, an ARB and a CCB there isn;t a whole lot left except to up the ACE dosage.
Eventually that will stop giving results as well because the body finds alternate routes to making Angiotensin-2.

You will have to start thinking in terms of combo drugs, or non drug treatments for hypertension. Perhaps an ARB-diuretic combination?

But for now 5 mg. of Altace sounds like a good idea...if it works.

[evelyn1]

Thx Lenin.

What about this twinge in my lower back? Could it be a kidney issue, and if so, could that be affecting bp? My mother has arterial stenosis in one kidney, so I'm paranoid about that.

[Machaon]

Originally Posted by evelyn1

i've read on this site that many people develop a resistance to ACEIs after 6 months.

thanks.

I've been on Accupril, an ACEI, for many years, and it is just as effective as it was when I first started taking it. In my experience, it has more of a lowering effect on my Systolic than my diastolic.

I've taken my blood pressure about 17,000 times over the past seven years and when I produce charts and reports showing the trends in my blood pressure, I also have comments such as "Stopped taking Accupril 10mg" or "Started taking Accupril".

OTOH, none of us on Healthboards are health professionals or have had any medical training, so what you read is only from our own personal experiences. From long term studies that I have read, ACEIs remain effective for long periods of time.

[Lenin]

beerzoids,

Look at a couple more studies.
Many sources show an increased production of Angiotensin from CHYMASE once the normal route is blocked by an ACE inhibitor. It can happen pretty quickly.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_u ids=7664213&dopt=Abstract

There are at least two routes around ACE inhibition to producing Angiotensin-2. One involves bypassing Angiotensin-1 completely via tissue plasmionogen activator (thus angiotensin directly to Ang-2)...the other is the use of chymase (instead of ACE) to convert Ang-1 to Ang-2.
Both these processes eventually counteract almost completely the effect of the ACEI. Thus the frequently seen situation where one's dosage of an ACE is increased and increased or supplemented with diuretics and channel blockers.