Blood Pressure - Enalapril (+1 More?)

[luumak]

I am currently seeing a doctor for high BP. Things have gone fairly well with enalapril but I have noticed that I have not really gained anything from moving from 10 to 20mg. I am about 123/84 (still not good enough).

I requested that we start with a non diauretic (sp) due to the heat here as well as this usually is related more to Systolic. My main issue is w/ Diastolic. Enalapril seems a good choice thus far and is cheap

Of course I will consult w/ the doctor next month but curious any meds you may recommend in addition. Im not really happy about any meds, especially multiple meds; I dont like "being sick" and "taking pills". CAn I continue with antihypertensives or need something else. I am happy not to be taking any blockers or diauretic. I need to lower the Diastolic.

I have cut back on the amnt of Thai food I eat but still continue to drink too much and the evenings I go out, often smoke cigarettes a few nights a week (I had stopped for years). I walk at least 2-5km a day and my BMI is in range.

I should really concentrate on lifestyle change but barring that - what might be the next course of action. I want to get my BP to in line w/ latest USA CDC reports <120/<80 (Id be happy with stable 80)

Thank you anyone -

============================================================================

Study on the effectiveness of enalapril as a monotherapy in mild to moderate hypertension.

Poulose M, Jayadevan R, Peter JV, Cherian AM

Department of Medicine, Christian Medical College & Hospital, Vellore,

Correspondence Address:

Poulose M

Department of Medicine, Christian Medical College & Hospital, Vellore

This study highlights our experience with 53 patients with mild to moderate hypertension who had monotherapy with Enalapril, one of the newer Angiotensin Converting Enzyme inhibitors. Enalapril was found to be effective in controlling blood pressure in 41 patients (77%). In 12 patients (23%) addition of one more drug was necessary for control of hypertension. Side effects were noted in 9 patients (17%). In two patients the adverse reactions were severe enough to warrant withdrawal of the drug.

Edited November 3, 2007 by luumak

[zzdocxx]

Well there are other classes of anti-hypertensives.

Calcium channel blockers.

Angiotensin II blockers.

Anti-adrenergics.

Why do you not want to take beta-blockers? Just wondering.

123/84 hey it is not too bad.

The exercise is great, but how much are you drinking, and how much are you smoking? How old are you? Is this your only medical problem?

Good luck!

[Mobi]

I take so many meds to keep my BP under control I reckon my stomach rattles when I get up in the morning

If I had 123/84 I'd be over the moon!

Try to cut down on the booze and do regular exercise - jogging, swimming, treadmill or something cardio vascular.

I really don't think you have too much to worry about, and if you do worry, your BP will go up

[luumak]

Hello and thank you both. Well, w/o the enalapril i was logging numbers like 145+/98+, it has done wonders and I must say I dont have any side effects.

I really should cut out the smoking (when my friend leaves in a month?) as for drinking this is about it:

2 nights 5 whiskies and 7 beer/s

2-3 nights no drinking

2-3 nights 2-4 whisky-water

my SGPT was 69 when I was really on the sauce (I also take paracetomol for sinus/hangovers). I took a healthy holiday and before I went on meds my SGPT was 40 (high side of acceptable. I will check again in Dec. This test is related to liver function (drinking) but also enalapril can mess with th eliver as well.

I read somewhere that alpha/beta blockers were really nasty especially if mixed with other meds. Something about nasty contrindiacation. I did not want to get started on them therefore becasue I am young and worry if I need to use other meds later in life.

I am 47/8 years old.

I used to eat Thai every day but now eat porridge in the morning w/ fruit and salad/bread for lunch - I really miss the Thai food :-(

Anyway, I thought I would get some info here before I return to the Doctor.

Yeah Mobi, I really need some real cardio sure.

[Mobi]

Well I've been taking beta blockers for years, and have had no serious side effects other than to slow my heart rate - which is very good.

I don't quite understand your problem with Thai food. OK, like any ethnic cuisine, there is good and bad, and you should certainly avoid the deep fried, too much sugar, salt and MSG, but if you're eating home cooked Thai food, and not over indulging, IMHO the good outweighs the bad, and will not adversely effect your BP or anything else.

As with all things, moderation is the key. Plenty of fresh fruit and veg is important. Both my cardiac and diabetic consultants here are perfectly happy with me being largely on a Thai food diet, but my old specialists from the UK were always worried about it. But their knowledge of Thai food was restricted to the large plates of 'Farangised' Thai food that they enjoyed in 5 star hotels and /or up- market Thai restaurants in the UK.

Smoking is real bummer for the heart - IMO even worse than alcohol. Quit if you can.

[ProThaiExpat]

I have been taking blood pressure medication for over 40 years. Started on diazides with potassium supplement, but really wasn't ideal for me and the cardiologist switched me to beta blockers and bingo, one pill a day and I was well controlled.

Stayed on beta blocker for more than twenty years without side effects. Now I take one Prenolol 50 mg. a beta blocker @ 2 Baht a pill, one Dinazide a diuretic 50 mg @1 Baht each and one Enaril an ace inhibitor 5 mg. @1.5 Baht each and my pressure is usually below 140/80. If I go off the diuretic my systolic goes over 140.

I do take three readings of my pressure when I measure it, and usually in the morning when blood pressure is usually the highest. No side effects that I can tell except to lower my libido which is not bad at my age.

Titration or trying various "recipes" to determine which meds work for you is the usual approach used by most knowledgeable physicians. Yes it would be nice to have only one drug do the trick, however, since each category of anti-hypertensives work in a different way, I like a three way approach rather than a strong dose of one drug.

[Sheryl]

Smoking is indeed the culprit. It causes constriction of the blood vessels. In fact, if you blow cigarette smoke over a (live) frog's legs and look through a microscope you will see the vessels clamp right down.

Odds are that if you stop smoking you will be fine on 10mg of enalapril daily.

If not, could try switching to an anmgiotensisn II inhibitor (the various "__sartans", like ibresarten aka avapro). They are very potent drugs, but they are also much, much more expensive.

So you have a choice. You can keep shelling out money on cigarattes plus spend a significant amount on antihypertensive meds in order to get your BP under control...meanwhile remaining at risk of lung cancer, emyphsema and heart disease (plus other problems)

OR

you can stop smoking and save all that money as well as reducing the risks of all of those other diseases.

It's that simple. Of course, I don't mean to imply that quitting smoking is easy, it is not. But it is by far your most pressing health need and it seems kind of silly to be worrying about a few points on your diastolic BP when it's the smoking that is most likely to do you in or disable you.

Good luck

[luumak]

WOW, I cant thank you all enough, this is really good info.

Sheryl: I dont smoke all that much, perhaps a pack a week (although I may also take a few small high quality cigars as well). 2-3 months a year, I dont smoke cigarettes at all. I really must put the smoking down (again). It wont be difficult, just developed the bad habit from too much dead time in the (smoky) bar. You are absolutely correct and not only have I quite for years prior, despite smoking for years I can quit cold turkey and be done with it. Interesting perspective though.

Mobi: its when I analyzed the food, full of salt (salt, msg, nam pha, seasoning...). add to this its almost always fried and finally tropical oils + coconut milk.

ProXpat: My systolic is not as big an issue, hence no diuretics. Thanks for the info on Beta's.

zzdocxx: BTW I assume/d that if you are taking a certian class of meds, you want to try another otherwise your sort of duplicating the effects. so w/ doctors advice I will try beta's but I don't know about the anti-calcium drugs. At this point, I don't think thats an issue, maybe ten years (mri test??)

Thanks everyone for this information very much.

[Mobi]

Mobi: its when I analyzed the food, full of salt (salt, msg, nam pha, seasoning...). add to this its almost always fried and finally tropical oils + coconut milk.

The emphasis is on home cooked Thai food where you can control the input. My wife cooks really delicious food (it's not just me - everyone says so - she used to run a restaurant), but she is very aware of the 'wrong/unhealthy' ingredients. I'm am an insulin dependant diabetic as well as suffering from hypertension, so my diet is critical.So the answer is minimal amounts of of salt, nam pla etc, use sugar substitutes, always use virgin olive oil, (or even sunflower oil), and keep deep fried dishes to the minimum. No msg, and always plenty of veg. Boiled rice , not fried rice, steamed or grilled fish rather than fried fish, grilled or barbecued meats, and so on and so forth.

And last, but not least, don't over indulge. I have unsweetened cereal with no fat milk and fresh fruits for breakfast, rice with one small dish for lunch, and rice with two dishes, one of which is vegetarian for dinner. If you have 3 smallish meals a day, you will be satisfied and it will help you lose weight and keep your body in shape.

[wca01]

In a very short time Enalapril (20mg) has helped me to reduce my blood pressure from 180 to about 110 - 115. After sporting activities my pressure sinks under 100. My daily headaches are gone. I feel like "reborn".

WCA

Edited November 5, 2007 by wca01

[luumak]

Mobi - Well, thats a heavy burden and I can certainly see how if you cook at home you can control what you eat. Thats why I've moved to porridge/fruit and bread/salad. I honestly love Thai food. I could eat it every meal. Something interesting is that I have found that all the bad food items do not impact my BP all that much.

WCA: you know whats interesting, I have for years had headaches that I attributed to alergies that I could not identify. Now on the Enalapril, I do not have the headaches.

Sheryl: Not to belabor the point or yourself. How long after I quit smoking should I see a lowered BP rate (stable)?

I took a long holiday a few months back and got some serious hard daily walking in but I would not call it cardio. I often wonder if I got some real cardio in if it would basically solve the problem.

Thanks 2 all and good luck with it.