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  • Switching from ACE to ARB

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    Old 10-24-2003, 08:11 PM   #1
    diitto
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    Post Switching from ACE to ARB

    Hi... I wrote a topic a few weeks back suggesting this might happen and now it has... My doctor has decided to switch me from 20 mg per day of Lisinopril (ACE inhibitor) and 10 mg per day of Atenolol (Beta Blocker) to an ARB (Diovan). My blood pressure has been very well controlled (averaging 115/65) for some weeks now but 1) I have that very difficult, dry tickle cough that sometimes comes with ACE inhibitors and 2) my potassium levels have been on the rise. That is up to 5.8 mmol/L and he says we don't want it to go any higher... Now I understand switching to the ARB from the ACE should remove the cough but the ARB will not necessarily lower the potassium. Does anyone here have a comment about that, particularly the potassium part?? And he is telling me to stop both the Lisinopril and the Atenolol (my heart rate is quite low, typically 45) and to take 40 mgs of Diovan instead. Doesn't 40 mg's sound a bit low??

    Right from the Diovan website it says, "DIOVAN 80 mg delivers the strength of Norvasc 5 mg, Zestril 10 mg, and Vasotec 20 mg*".. And Zestril is Lisinopril. I was on 20 mgs of that and 10 of Atenolol and now he is telling me to break 80 mg Diovans in half and take only 40. I think he is hoping that a very small dose of anything can work for me now and that also by taking a low dose of either an ACE or an ARB that perhaps that might begin to lower this rather high potassium I currently have...

    I have some sort of yet unknown kidney problem, likely Renal Artery Stenosis, that started all this blood pressure stuff back in August... And my blood pressure then went through the roof, 220/135 and I landed in the hospital. Bottom line is I can't allow my bp to head anywhere in that region again so I am going to do what he says but be all over the phone next week if my bp starts to head up on only 40 mgs per day of Diovan... Anyone ever been on both Diovan or some other ARB and a Beta Blocker at the same time?? Do those mix or no??

    Any thoughts from any of you folks?? I appreciate the help... Thanks... diitto

     
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    Old 10-24-2003, 10:52 PM   #2
    maxjasper
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    I hope this be of some help to you:

    [url="http://bmj.bmjjournals.com/cgi/reprint_abr/326/7404/1427.pdf"]Value of low dose combination treatment with blood pressure lowering drugs: analysis of 354 randomised trials[/url]

     
    Old 10-25-2003, 10:07 AM   #3
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    Diitto- Max's link is interesting and it's conclusions indicate that a low-dose combo drug treatment can be very effective and reduce side effects.

    Yes, Betas and ARBs are often prescribed together.
    But I'm confused...unless I missed it in your post.
    Are you now ONLY on the 40mg Diovan, or taking it with the atenolol? I thought the doctor told you you stop taking the latter (?)
    40 mg Diovan alone makes no sense.

    My biggest question is, if renal artery stenosis is the cause of your hypertension in the first place, thereby putting you in the catagory of folks with secondary hypertension, is anything being done to address this? Angioplasty? Fix the stenosis and bye bye hypertension. (Easier said than done I know).

    zuzu xx

     
    Old 10-25-2003, 01:17 PM   #4
    diitto
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    Hi folks... Thanks for your responses... ...And Zuzu, yes, he wants me to drop both the Atenolol (Beta Blocker) and the Lisinopril (ACE inhibitor) and go with ONLY 40 mgs per day of Diovan. But there is one more piece I didn't talk about in my earlier post. They discovered when all this high blood pressure hit back in August that I am also hyper-thyroid. I have been on Tapezole for the past two months and my doc now thinks that has kicked in and that my entire system is "revved down" enough now that perhaps I can fall back to just one low dose of a bp medicine and the Diovan choice is due to me having a tickle cough on the Lisinopril. Plus my potassium has drifted quite high as I said, which tells him that if you are to stay on either an ACE inhibitor or an ARB to go with the very lowest dose that will keep the bp in check and hopefully allow the serum potassium to come back down. So his thinking is that the anti-thyroid med (Tapezole) is helping quiet my system down enough that whatever assistance my thyroid might have been playing in making my heart beat faster or whatever might be now out of the picture such that I might be able to get away with just a low dose of say Diovan.. Admittedly I was expecting him to put me on 80 mgs of Diovan, not 40. He actually gave me 80 mgs (it doesn't come in lower doses I don't think) and told me to take 1/2 pill per day and if need be to up that to a full pill per day... Plus he knows that I am monitoring my own bp at least twice a day...

    And regarding your question about what might have been going on from the get go, yes, today the theory is that I likely have Renal Artery Stenosis to my right kidney. I had a renal ultrasound a month ago and my right kidney is about 60% of the size of the left kidney which they described as normal (the left kidney that is). We are in the midst of getting the medical plan approvals to do an MRA (magnetic resonance angiography) of the renal arteries to see if RAS is really what is going on. The hyper-thyroid was a coincidental discovery when all this first happened (spent a day in the emergency room with sudden onset of high bp, 220/135). A thyroid doc said it is unlikely the thyroid caused all of this but some other condition (like RAS) might have been lurking in the background and the onset of hyper-thyroid might have caused things to sort of fall off the cliff. And yes, if RAS is discovered, the likely path would be balloon angioplasty and a stent... And yes, it sounds pretty doable (the angioplasty) but needless to say I am not very excited about such a prospect... I am 51 and was quietly hoping to get a few more years down the road before such things began to hit but ooops, it seems to be choosing to come now... sigh...

    Holler back with any thoughts and thanks... diitto...

     
    Old 10-26-2003, 09:40 AM   #5
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    Diitto- Now that you've outlined your scenario, it all makes sense to me.
    It would be great if the 40 mg Diovan keeps the BP in check, and your doctor(s) seem to be approaching everything in a responsible and thorough manner.

    Keep us posted about the MRA.

    Good luck!

    zuzu xx


     
    Old 10-27-2003, 07:00 AM   #6
    zip2play
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    Ditto,

    One slight correction. The ARB's have been shown to cause LESS coughing that ACE inhibitors.
    I have found some coughing with Cozaar...but nothing NEAR the horror that was the VASOTEC hack.

    I find the ARB cough slight and infrequent but still there.

     
    Old 11-16-2003, 01:15 PM   #7
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    Combination drugs

    I had the usual run around with all the classes. Betas made me fell 90 years old. Lotrel rotted, gave me the coughs plus norvasc had a lot of side effects and accupril the same. HCT tons of side effects. I'm on diltiazem 360mg and benicar 20mg.No real side effects- I run a 1/2 marathon and average 18-25 mile a week running. I still wonder about the diltiazem- I don't feel any side effect but I'm not real real confident on the long term effects of channel blockers. Dilitiazem is supposedly a mild channel blocker and I swear by ARBs(especially diovan and benicar). Diltiazem will lower your pulse (mine is resting 54-59BPM). So this is a great combo for me.

     
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