Bp: Stubborn Systolic

[rhubarb73]

Hello - I'm not looking for medical advice and I will discuss with my GP, but interested in perspectives and observations from others in the same boat.
I expect many others with T2 are also battling hypertension. I'm in that boat and started on 5mg of ramipril which brought the BP to close to target levels.
Because I wasn't consistently over the line, my GP increased the dose to 10mg. Since then the diastolic reading has always been well in the safe zone.
The systolic though remains stubbornly high between 135 and 150. If anything it has increased since the dose went up.
All of the other factors should be in its favour: diet, exercise, weight, alcohol - all going the right way.
Is there another factor I'm missing: Metformin, statins - can they push it up? Does the diabetes itself increase the BP?
It's bugging me because everything else is going in the right direction.

 

[bulkbiker]

Do you measure at home as well as at the docs?
I found I had white coat syndrome quite badly and that home readings were always lower than at the surgery. Also after about 6 months of low carb and intermittent fasting my blood pressure normalised without meds.

 

[rhubarb73]

good question - I measure at home. I've calibrated my kit against the doc's. I do have a bit of white coat syndrome but that's not the issue here. (and it is only the systolic that is peaking too high).

 

[Rachox]

I am on Ramipril and I was on another med, Amlodipine (because I got headaches if the Ramipril dose exceeded 6.25mg) for raised BP. I had been on both for a number of years. After nine months of low carb eating and significant weight loss my BP had settled down enough to stop the Amlodipine. I too get white coat syndrome, so habitually take a week’s worth of daily readings to any routine appt now. It does appear that Diabetes and hypertension do often go hand in hand unfortunately.

 

[lindisfel]

Hi,
Ramipril works on the RAAS system and will only work if you are triggering this system by increasing renin or it is hacked by excessive insulin.

It you have high sodium it switches the system off anyway. But high insulin makes it work and it puts up BP and increases aldosterone and constricts blood vessels. So going low carb will bring down your BP and you lose fluid mass as well.
Unless your like me and I have an aldosterone producing adenoma that causes my body to retain sodium.

In your position I would keep taking the Ramapril and cut down on carbs and ignore the suggestions to increase your sodium intake and see what happens? You should see a difference within two weeks in BP.

Amlodipine works in a different way.

Sometimes angiotensin 2 inhibitors work better for some and I take losartan as well as an aldosterone antagonist.
regards
D.

 

[lindisfel]

If one has problems with an angiotensin 1 antagonist an angiotensin 2 antagonist like Losartan will probably work and stop the cough. I don't think statin ever help my BP when I took them that's not their purpose as far as I know.

I take clonidine which works well but is tricky in that you cannot be late on a dose

I didn't do well on your kind of drug and cannot have statins.

https://www.medicalnewstoday.com/articles/278164.php

web md on hte side effects of your heart drug:

Side Effects
Dizziness, lightheadedness, or tiredness may occur as your body adjusts to the medication. Dry cough may also occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

Tell your doctor right away if any of these unlikely but serious side effects occur: fainting, symptoms of a high potassium blood level (such as muscle weakness, slow/irregular heartbeat).

Although ramipril may be used to prevent kidney problems or treat people who have kidney problems, it may also rarely cause serious kidney problems or make them worse. Your doctor will check your kidney function while you are taking ramipril. Tell your doctor right away if you have any signs of kidney problems such as a change in the amount of urine.

This drug may rarely cause serious (possibly fatal) liver problems. Tell your doctor right away if you notice any of the following rare but serious side effects: yellowing eyes/skin, dark urine, severe stomach/abdominal pain, persistent nausea/vomiting.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Related Links
List Ramipril side effects by likelihood and severity.

 

[lindisfel]

And you can end up with permanent diarrhea on an ARB. The longer you are on an ARB, the more likely this particular side effect. I was on one for 7 years before I had to quit.

Well it don't give me the runs and I have been on ARBs 15 years or more. If an ARB makes you run Metformin would give you Montezuma's revenge!

I wouldn't post the side affects of clonodine they sound b.a.!

All medicines are poisons but some poison us quicker than others.

A good doctor keeps an eye on your liver and u&e's and takes note of any problems.
He'll know why he has put you on an angiotensin 1 antagonist.

The best approach Rhubarb is to tackle your T2D and it will cut your need for bp meds.
D.

 

[DavidGrahamJones]

I expect many others with T2 are also battling hypertension.

My own personal cocktail of drugs (Doxyzosin, Lisinopril and Amlodopine) seems to keep my numbers very close to the 120/80 mark, very occasionally higher systolic combined with lower diastolic (130/70). There was a time when my GP was more concerned about diastolic readings than systolic, and although now treats both with the same concern, she isn't too concerned about my occasional "blips".

 

[rhubarb73]

The best approach Rhubarb is to tackle your T2D and it will cut your need for bp meds.
D.

Thanks- that’s sort of what is bugging me. The T2D progress is going well: weight down, BGL down - both significantly. Diastolic down. Systolic misbehaving. Will persevere with T2D treatment anyway (no choice). Maybe a bit more patience needed.

 

[bulkbiker]

Thanks- that’s sort of what is bugging me. The T2D progress is going well: weight down, BGL down - both significantly. Diastolic down. Systolic misbehaving. Will persevere with T2D treatment anyway (no choice). Maybe a bit more patience needed.

Come on you've been here for what a month and a half? and you want everything fixed already?
Give it a chance ...!
At your youthful age it will happen but it took 44 years to get you to Type 2.... 44 days to fix it might be a bit too short..

 

[rhubarb73]

Come on you've been here for what a month and a half? and you want everything fixed already?
Give it a chance ...!
At your youthful age it will happen but it took 44 years to get you to Type 2.... 44 days to fix it might be a bit too short..

Having it all fixed would be natural BP reduction and no need for medicine - I am prepared to play the long game on that.
I would like the BP to respond to the BP medication and it isn’t (systolic at least). Ramipril is meant to act quite quickly, but I’m guessing the T2D might impede that.

 

[bulkbiker]

Having it all fixed would be natural BP reduction and no need for medicine - I am prepared to play the long game on that.
I would like the BP to respond to the BP medication and it isn’t (systolic at least). Ramipril is meant to act quite quickly, but I’m guessing the T2D might impede that.

Personally I’d stop all the meds and give the new way of eating a real chance.
Are you taking statins too? If so why?

 

[zand]

I was off all medications for a while, then went back on a BP med - Losarten. I found this better than Ramipril which made me cough and wasn't very effective. I am desperately trying to lose more weight so that I don't need any medication at all, but in the meantime I am happy on Losarten.

 

[lindisfel]

c.10% of resistant hypertensives have adrenal problems that cause the RAAS to be overridden, if your doctor is up to speed he/she should know this fact and check you out perhaps using a drug like spironolactone on a temporary basis to see if your BP comes down?

Spironolactone blocks the action of aldosterone by closing off aldosterone receptors that work to increase retension of sodium and increase BP.

Ask you doctor, the fact your drug is not working is interesting.

The RAAS puts up BP via an aldosterone increase and constriction of blood vessels if people who are healthy have too little sodium in their bodies.
It is a human survival mode.
This is why low salt is bad for non hypertensives it constricts blood vessels and is bad for the heart because it increases aldosterone.

Having got Conn's syndrome I normally have 20x the normal amount of aldosterone in my blood.
I can only trigger my RAAS via a low sodium diet and the aldosterone antagonist Eplerenone.
Having done this my RAAS starts to work again because renin goes up, and there an even bigger leap in aldosterone production from my tumour.
I stop this with losartan which blocks angiotensin 2.

It took nearly 30years of hypertension and a brilliant cardiologist at Newcastle to find out my source of hypertension. A source that is very much overlooked by GPs.

One reason why T2D have high BP is if they have hyperinsulinemia. High insulin hacks into the RAAS thus putting up BP. I guess this why some authorities feel T2D should be on drug that stops the RAAS working, like losartan for eg that blocks angiotensin 2. LCHF should help this if your renin response is normal because insulin drops.

D.

Having it all fixed would be natural BP reduction and no need for medicine - I am prepared to play the long game on that.
I would like the BP to respond to the BP medication and it isn’t (systolic at least). Ramipril is meant to act quite quickly, but I’m guessing the T2D might impede that.

 

[lindisfel]

Personally I’d stop all the meds and give the new way of eating a real chance.
Are you taking statins too? If so why?

You can't fix everything by diet bulk biker, sometimes drugs are necessary. D.

 

[bulkbiker]

You can't fix everything by diet bulk biker, sometimes drugs are necessary. D.

There are certainly some things that drugs can help with but from my extensive reading metabolic problems are best cured by proper fuelling rather than mucking about with pills.
Blood pressure, Type 2, obesity, "cholesterol" are all interlinked and by messing about with one we probably upset the apple cart for all of them. Our bodies after all are "designed"/have evolved (delete as per personal belief system) to work not to be ill.
Doctors are still way too keen to reach for the prescription pad rather than look at root causes. Covering up the underlying problem using pills doesn't help anyone in the long term surely?

 

[lindisfel]

Even Prof Phinney doesn't suggest people who need them should stop taking statins! So it's a mixed feast, I wouldn't take statins.
D.

 

[bulkbiker]

Even Prof Phinney doesn't suggest people who need them should stop taking statins! So it's a mixed feast, I wouldn't take statins.
D.

I would counter Phinney with who needs statins? And likewise I wouldn't take them..

 

[zand]

I would counter Phinney with who needs statins? And likewise I wouldn't take them..

I agree with you re statins. I don't believe that high cholesterol is a problem so why mess with it?

High BP however is a problem which is why I would rather resort to a low dose BP tablet to help keep mine under control. My BP once rose to 240/180 and I wouldn't want to risk that again. I suffered a little permanent damage to my eyes because of this. I was on 7 tablets a day at one stage (for heart and BP). I was drug free for a while but am now having 1 tablet for BP and 1 tablet every other day for depression. My aim to is get drug free again, and the anti-depressant is the next on my list to go, but I am doing this really slowly.

My point is that whilst being drug free is a sensible aim, some of us need to take them to stave off complications from other health problems.

I know that for me the key is weight loss, but losing weight isn't easy for me. I can control BGs fairly easily, but losing the weight....that's a different story. If I manage to lose another stone then I will reassess the drug situation - but that's a big 'if'!

 

[rhubarb73]

Personally I’d stop all the meds and give the new way of eating a real chance.
Are you taking statins too? If so why?

Given my history I’m sticking with the meds. Hypertension predates T2D by several years. I came off BP meds a year ago and it rocketed.
Low dose got me back to 140, but doubling the dose hasn’t given any sort of return.
I’m going to fight this on two fronts and scale back if I can when the stats are healthy and stable. Thanks for the challenge though - the perspectives and experience of others is really useful food for thought.