Ace inhibitors

[kiwi]

I've taken an ace inhibitor (quinipril) for about 20 years for high blood pressure.

I've read in a number of places here that ace inhibitors are not recommended for people with HCM, but can't find out why.

I'm now also taking verapamil for HCM - the consultant said he wouldn't prescribe a beta blocker as I have asthma.

I'm going to my ordinary physician next week, - need another round of prescriptions, and want to be well prepared for the discussion.

[Reenie]

The reason that ace inhibitors are not normally recommended is they tend to make the heart beat more forcefully. HCM hearts already do an outstanding job beating, for the most part. You might want to ask your doctor if there are other drugs that can work as well to lower the blood pressure.

Reenie

[baw578]

My brother and I had asthma as a child but my brother had it worse. Both of us are on Atenolol 50mg twice a day. It is a Beta-Blocker but the doc told me that this beta-blocker doesn't effect the lungs. I did take 250mg of verapimil once a day but I was allergic to it and then they switched me over Atenolol. My brother was on Calen SR and switched to Atenolol. We have the same doc now.

[vtmobile]

ACE inhibitors

like you, I've been on ACE rx now for about 4 years. I've discussed this with my cardiologist as well as my Cleveland Clinic cardiologist. The drug does a beautiful job of keeping my blood pressure down with no side effects. Everyone seems to be happy with it in my case. I've been told that there is no clear contraindication against its use, but you should consult a cardiologist familiar with HCM. Some believe that it may slow growth of the heart, but there is no evidence in man that it does this.

[Burton Borrok]

When I was diagnosed with HCM, the first thing they did was to discontinue my ACE inhibitor. I was then on 50mg of Atenolol and 360mg of Verapamil/Calan. Later, 2.5mg of Norvasc was added to the mix.

Now, because of my kidneys limiting the amount of diuretic I can take, the Atenolol has been increased to 100mg, the Verapamil has been replaced by 360mg of Diltiazem TR, and the Norvasc 2.5mg has been continued. This seems to be working well. I am also now on a pain patch of Duragesic so I’m not sure which medication is doing the trick, but I have a lot less angina of late. It may need some fine tuning as time goes by, but right now I’m happy with the situation.
Burt

[kiwi]

Ace inhibitors

Thanks for all the contributions. They've really helped.

As it turned out when I went back to my general practitioner I mentioned the issue and described the findings I'd read of, but she is unwilling to take any action on medication, said it would be up to the specialist to make any changes. I won't see him again until the end of the year.

She did say that my blood pressure is down to a reasonable level, and that the heart murmur is quieter than it was last November.

It was interesting to realise how much I knew about HCM from reading the material here and on related sites. Once again many thanks.

[Burton Borrok]

Hi Kiwi,
I can readily understand your PCP’s position that she doesn’t want to mess with the drug regimen set up by your cardiologist. On the other hand, could it be that your cardiologist does not know the details of the relationship between HCM and ACE inhibitors?

Even though things look kind of OK to your PCP at this time, in your shoes I would write a letter to my cardiologist about the situation. I would include excerpts from information I found on various sites about the subject (including the references to the articles and their titles.)

Most doctors spend most of their research hours on conditions that come in their door every day – as they should – and your doctor may just not be up to snuff on this particular situation. It sure doesn’t hurt to help him look into it before he gets back to you, and advises you on what to change in your medications – or why you should not change anything at this time. I just can’t see ignoring it for another ten months.

By the way, every kiwi I’ve ever seen has been green. Does it follow that you . . . ???
Burt

[dughr]

Hi Kiwi,

I wouldn't worry too terribly much about this. I have HCM and had a myectomy in July of 2003. Since then Dr. Maron and Dr. Udelson who are two of the top doctors in the HCM community have me on Verapamil for the HCM and Lisinopril ACE inhibitor for high blood pressure. Although they both have said it isn't their FAVORED combination and in most cases the ACE is not their first choice in an HCM patient, it has done wonders for my blood pressure. I feel fine on them and that is the best indication. If you don't feel the drugs are working in your best interest then it is a good idea to force the issue, but I doubt it is super critical if you feel good and are getting good results.

Doug