01/01/2023
Should Sam Stop his Ramipril even-though his blood pressure has been perfect for a week without taking any meds ???
First let’s agree on one thing, is to never stop , initiate, change dose of any of your medications without consulting with your doctor or pharmacist.
Secondly, the reason i chose this topic because in my 15 years of practice i was asked this question over 100 times if not more .
Third , our mission is to educate people about their meds , there is a high percentage of in-compliance in Canada in general . Especially in a situation like this where the patient sees that the blood pressure is normal without the meds , so why take it ??
To answer this question we need to talk about Diabetes, and one of the effects of Diabetes is direct on the kidneys : in more details , Diabetes causes dilation of the main arteriole that passes blood into the kidneys ( The Afferent arteriole) and causes constriction of the arteriole that passes filtered blood through the kidneys back to the body after detoxification , the Efferent Arteriole ( refer to the picture linked to understand more what is meant by these arterioles ) .
The problem is more pronounced in Diabetics , and the cause is a hormone called Angiotensin 2 . This hormone causes the efferent arteriole to constrict
Now imagine a reservoir with a large pipe feeding the reservoir and a narrow pipe exiting the reservoir.. what will happen?? The reservoir becomes under a tremendous pressure, too much water going in and more than 50% of that water cannot exit because of the narrowing of the exit pipe ( in our case the Efferent arteriole ) what happens next ? The reservoir starts leaking water .
Now exchange the reservoir with the kidneys , this happens in Diabetes and the kidneys start leaking a protein called Albumin , and this is one way to check kidneys function : if there is protein in the urine and if yes how much ?
The hormone that causes the constriction of the Efferent Arteriole is called Angiotensin 2 . So of we stop that hormone from working we will preserve kidney functions by not allowing the constriction of the Efferent arteriole and so protecting the kidneys .
But , what classes of drugs stop (inhibit) the action of the enzyme that prevents converting Angiotensin 1 into Angiotensin 2?? The problem hormone?
There are 2 main groups :
1- ACEI : Angiotensin Converting Enzyme Inhibitors : from the sound of it , it stops the enzyme that converts Angiotensin 1 into Angiotensin2 which causes constrictions all over the body including the efferent Arteriole . This way we accomplished two things : reducing blood pressure by dilating arteries and Arterioles across the body= less pressure on the walls of the blood vessels = lower blood pressure
And secondly, we rescued the kidneys from long term damage .
So even if your blood pressure is normal without the drug , you should continue taking it to preserve kidneys from damage , if the dose is too high since blood pressure was normal without the med , i would reduce the dose to the half or quarter , of course after consulting with your doctor or pharmacist
Examples: Ramipril, Lisinopril , Captopril , Enalapril ,..etc
2- ARB’s : Angiotensin Receptor Blockers : this group is second line to the first group ( because it’s more expensive and the government pays for the first group . And only pays for this group if you had a side effect using group 1 which is mainly a dry hacking cough that will not go unless you stop it , then the doctor applies for what’s called BC Pharmacare Special Authority. And the government then list this medication as a benefit medication for you .
This group works a bit different with the same outcome, it doesn’t prevent the conversion of the hormone Angiotensin 1 to the trouble maker Angiotensin 2 ! But it blocks the receptors onto which Angiotensin 2 attach and cause an effect ( in our example the Efferent arteriole and other blood vessels across the body ) and so lowering blood pressure and preserving kidney functions
Examples: Losartan , Candesartan, Irbesartan , Telmisartan , olmesartan ,Valsartan .
Generally speaking in Diabetes there are 3 Milestones, or objectives for therapy :
1- Control blood sugars ,
2- Control Blood Pressure
3-Control blood lipids (Cholesterol, LDL ,HDL , Triglycerides, Ratio )
I hope i was able to explain this using non medical terms as much as possible to cross by the idea and the importance of ACEI medications. And the importance to be on them .
So if you are a diabetic and not on one of the two groups, question that with your doctor . The only times that you cannot take these meds are :
Any patient with a history of angioneurotic edema, whether related to an ACE inhibitor, angiotensin receptor blockers, or another cause, should not be given an ACE inhibitor. Other contraindications include pregnancy, renal artery stenosis, and previous allergy to ACE inhibitors.
We will pronounce the winner later today and you can receive the gift card on Tuesday .
Happy New Year everyone
Hopefully a year full of Health,Wealth and success
