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  • Should I switch from ACE inhibitor to ARB?

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    Old 08-15-2006, 12:30 PM   #1
    2muchdrugs28
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    Should I switch from ACE inhibitor to ARB?

    I am curious if people think I should switch to an ARB. I've read posts that some people develop resistance to ACE inhibitors over time and am wondering if that is happening to me.

    About 2 months ago, I went from a diuretic (12.5 mg HCTZ) + ace inhibitor (5 mg lisinopril) to just the lisinopril. At first, the ace inhibitor kept my blood pressure around 125 / 75, but now I sometimes get 130/80 readings. Without treatment, my BP is usally 150/90. Diuretics are marginally effective for my blood pressure and I tried Norvasc but did not the side effects from CCB's.

    My blood pressure has been increasing the last week or two and I sometimes feel heart palpitations (the palpitations happened before I went on treatment too). Anyways, I am wondering if I should ask to be on a ARB or higher dose of Lisinopril. 130/80 is not bad blood pressure but I would like to keep it lower. I am under a lot of stress, which probably contributes to my blood pressure.

    thanks,

     
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    Old 08-15-2006, 05:04 PM   #2
    Lenin
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    Re: Should I switch from ACE inhibitor to ARB?

    Why not put the diuretic back?

     
    Old 08-15-2006, 05:31 PM   #3
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    Re: Should I switch from ACE inhibitor to ARB?

    Lenin,
    I hated taking the diuretic. It didn't do much for me and gave me intolerable side effects, including really dry skin and sexual side effects.

     
    Old 08-16-2006, 04:27 AM   #4
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    Re: Should I switch from ACE inhibitor to ARB?

    2much,

    How long in total have you been taking lisinopril? Although the 130/80 average isn't bad there's good evidence that your body is acclimating to it. Usually this begins in from 6 months to a year.
    Probably your best option is to move up to a 10 mg./day dose, if not now, then later.

    Eventually you will probably have to move to an ARB but don't push it, take the ACEI as long as possible both because the ACEI is far cheaper and also is more effective at BP lowering than the ARB's.
    Incidentally, most people on ARB's confront the same dilemma: little use without a diuretic.

    Have you considered trying Lasix; it's quite different from thiazide?

    Last edited by Lenin; 08-16-2006 at 04:29 AM.

     
    Old 08-16-2006, 02:20 PM   #5
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    Re: Should I switch from ACE inhibitor to ARB?

    Lenin,
    I've been on Ace inhibitors for about 6 months. At first, I took Altace but then I switched to Lisinopril in June. Altace worked ok. I switched to Lisinopril because it is much cheaper.

    What is the advantage of Lasik over HCTZ? I'm hesitant to take a diuretic because my blood pressure really doesn't seem to change much with salt. I am only 29 and have healthy kidney function. I've never had a problem retaining sodium. I'm white too. Isn't salt sensitivity primarily a problem for black people and older people with declining kidney function?

    If anything, I think the biggest factor that modulates my blood pressure is stress and social isolation to an extent. About a year and half ago, I had optimal blood pressure 120/75 without drugs. But there were times before that when my blood pressure was high ~150/90.

    thanks

     
    Old 08-17-2006, 05:04 AM   #6
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    Re: Should I switch from ACE inhibitor to ARB?

    As you say,
    if you are NOT salt-sensitive with easy retention of pounds of water after a super salty meal, then diuretics aren't likely to be of a lot of benefit.

    My personal take on the major difference between thiazide and Lasix is that the thiazide seems to target SALT first and the water follows whereas the Lasix SEEMS to dump the water more directly...then soon retain it again to dilute the salt.
    Thus thhiazide lasts longer unless you eat more salt.

    I'm white but still have major water retention issues and thus have more need for diuretics than any other antihypertensive class...ARB's and ACEI's are almost useless for me.
    But people differ.

    There is also a group of mechanisms that, when ACE is inhibited or blocked, trigger a compensatory release of antidiuretic hormone which ultimately stops sodium excretion, rasing blood volume and pressure. So an ACE inhibitor can CAUSE water retention, another reason that the drug calss is very often accompanied by a diuretic.

    If you know someone on Lasix, take a 40 mg pill WITH breakfast (it won't dissolve in an acid medium) and see if it turns on the water works. If it does, it will likely be a very useful antihypertensive.

    Last edited by Lenin; 08-17-2006 at 05:12 AM.

     
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