Ramipril not working - what’s wrong with me?

[Feefour]

Sorry - I’ve posted about this before, but it’s causing me a lot of anxiety (ironically, which I know is bad for my blood pressure).

I had high blood pressure when I went to get my pill. I was given a 7 day monitoring form, which came back at 134/90. The gp said I could start on low dose Ramipril - 2.5mg. However, due to some confusion, I actually began on 5mg, which didn’t seem to make much difference. Last week it was put up to 7.5, and this morning my blood pressure is 140/95 - worse than pre diagnosis!

I can’t ask the gp because I’m supposed to be doing another 7 day form, so I need to wait until that finishes to make my point. But I keep thinking - what is wrong with me for this not to work? And what does it mean for the future if I can’t even get this ‘borderline’ blood pressure under control? Presumably it will get worse as I get older.

I’m only in my late thirties. I feel like I’m failing. Has anyone had this?

Not every medication works. My DH is on 2.5 mg Ramipril, but also takes 1.25 mg Bisoprolol. I have high blood pressure and have tried a few different blood pressure medications, I am on Perindoprol 2 mg and my blood pressure is usually around 135/85. I would call GP to check on dosage, do you take Ramipril in the evening, this may be why blood pressure is high in the morning. Most other bp medication is taken in the morning.

Thank you. I take it in the morning, though I don’t think it will have had time to kick in before my morning reading, if that makes sense.

Keep communicating with your gp. It might take a little while and a few changes in types of medication to work for you. There are several different types and they work in different ways.

As you say, stress doesn't help. Good luck, I expect it will be sorted soon

This isn't going to be much help but there was an item on (I think) 'inside health' on R4 about 6-8 weeks ago about how amazingly different the readings are if patient takes blood pressure pill in morning or evening. Evening medication was proved to be much more effective. Don't know if you can find the item on i-pkayer?

If you took it in the evening then record your bp in the morning would that show a different result.

Take two readings morning and evening for a week and average them out and give them to GP.

Are you of African ancestry by any chance?

I started the same medication yesterday but was told because I'm mixed race it might not work....

Thank you all. @noradelphine No, not of African ancestry. That’s interesting though - it shows that it doesn’t automatically work for everyone.

Interesting point about taking it at night, because I did read an article about that a while ago. I will try it at night, but I suppose I can’t do it this week while I’m doing the records for the gp, because it will mean not taking it for 36 hours, which could skew the results?

The more worried I become about there being something wrong with me, and why it isn’t working, the worse the readings get (understandably)! I feel like my own mind is working against me!

You should take ramipril at night. If you don't respond to it within a few weeks, despite increasing the dose, the GP will probably add a calcium channel blocker (probably amlodipine) or a thiazide-like diuretic (usually indapamide). If the blood pressure comes down and stays down for several months they should look at trying to withdraw one of them.

Do you mind my asking how old you are? Angiotensin-converting enzyme (ACE) inhibitors like ramipril and angiotensin receptor blockers (ARBs) like candesartan are less effective on average in people over 55. But even in under-55s only a certain proportion of people will respond to any individual drug.

@NoNotHimTheOtherOne I’m only 39. I feel so bad that I can’t control my blood pressure at this age. It doesn’t bode well for the future, I know.

I took the first dose at night, but the leaflet and the NHS website said it could be taken at any time of day after that. I will switch to night time, but I am supposed to be recording morning and evening for three GP this week. If I took it this morning and then don’t take it until tomorrow night, that will skew the results, won’t it?

In the beginning I was told that my blood pressure (133 / 90) was only borderline, so we would treat it aggressively with 2.5mg Ramipril. But now I’m on 7.5 and it seems to be getting worse. I just can’t make sense of it and it’s all I think about.

The fact that you are anxious when you take your blood pressure might be pushing the readings up. Perhaps try putting the cuff on when you first wake up and then lie quietly for 10-15 min before you measure it. Not easy if you have other people getting up at that time, I know.

If it genuinely is going up quite rapidly they will want to do some investigations for an underlying cause. Most hypertension has no identifiable cause (of course it has a cause but nobody knows what it is), but very high or rapidly increasing pressure will trigger requests for investigations of kidneys, thyroid, adrenal glands, etc. I had all these when I had BP of 240/160 mmHg a few years ago. They required a few appointments but were really no bother.

And don't draw any conclusions from a single measurement. You need all the measurements for at least a week. Having a 36 h gap between two doses instead of 24 h isn't going to make a huge difference. It might affect one measurement but it's not going to affect the average for the week significantly.

I have high bp due to kidney disease and it has taken a lot of tinkering with various medications and combinations of to get it under control over the past 4 years. I now have Ramipril 10mg, indapamide and amlodipine and I still have good days and bad days. I like to try and keep below 140/90.

Please rest assured that your bp isn't too bad at this point and damage to your health due to bp happens gradually over extended period of time. You're doing the right thing being monitored and GP will see you're sorted.

Don't forget to take an accurate reading ensure that you are sitting down for 5 mins before you take your reading, and that your cuff is the correct fit for your arm. Ensure you are adequately hydrated too.

Hi,
I have had chronic stress syndrome due to recurring family issues and other stresses but I live a daily un-hurried lifestyle and am calm and relaxed. On a routine check after full bloods test - all clear - my BP returned 185/135. No underlying issue. Heartbeat very very good and has been throughout. 1.25mg of Ramipiril brought it down to 158/110 in 2 days then spiked back up to 176/135 when I was taking a reading at GPs after a particularly anxiety inducing negotiation - triggers set me off. Dose was upped to 2.5mg and I ve done a week of it and though one great reading was 132/89, I have not got it down from 145 - 135 sys while diastolic is 93-95 and pulse is still only 66-71 etc. Moral of the story is one pill cannot stop whatever is causing it but only prevent it from rising higher when you get the right dosage. There are other issues. Anxiety in my case and perhaps something which is causing the heart to pump out more blood. Onwards to cardio and 24 hr monitoring etc and hope I can just carry on without other meds. I d love to know the cause but I never may. I feel good. 50 yrs, 67kg and no aches pains, etc. But I should move more for my asian body needs a lot more circulation and more social activity which keeps me relaxed. Reading lowers my BP too so much of this is our body getting to grips with how we are living our life. That's my take, the pill can only stop it rising not falling too much.

Its the drug not you.

Rampiril didn’t work for me at all. I’m now on something different and probably a lot more expensive

I’ve been on Ramipril for 6 months now and only starting to see a difference. My BP was around 140/100 and it’s been trying to get the right dosage of Ramipril and the odd propanol thrown in. It takes time and other factors. You may need a second agent or a different agent all together

There are other BP meds..you need to find the one that suits you. You seem young to have high blood pressure. Is the GP looking into why..could be just anxious.. I only need to look at a white coat and mines up. I did 24 hour monitoring. You wear it and it automatically takes a reading every half an hour inc through the night. That way you get an overall picture.

I take my Ramipril on an evening.
When I started on it it was too strong so it got reduced in half.

Rampiril is an ACE inhibitor. However, your elevated blood pressure might not be being caused by excess ACE so maybe you don’t need them inhibiting.

Your GP should probably try you on an alternative type of blood pressure med.

You can probably also do yourself some favours with lifestyle factors such as losing weight, reducing salt and eating beetroot to boost nitric oxide.

This seems to be my problem too...it's so frustrating