# ACE inhibitors



## martint235 (23 Mar 2016)

So I've just seen the cardiologist. I apparently have thickened walls to my heart and a 24h blood pressure test in Feb revealed BP of 141/90. At the gp on Monday it was 136/84. The cardiologist is surprised that someone who has cycled 1300 miles this year has this issue.

I have no symptoms so when he said he wants me on an ACE inhibitor I have initially refused. SWMBO thinks this is silly. I have reluctantly agreed to discuss it with my GP (we have a very good relationship).

Anyone putting lots of miles in while on this kind of medication? Should I concede or stand my ground?


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## vickster (23 Mar 2016)

Read up on the potential side effects with ACEi, especially cough. And look at the alternatives, I.e. ARB aka AIIA

High BP is commonly asymptomatic so that's not surprising and yours isn't really very high


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## martint235 (23 Mar 2016)

He mentioned the cough and said it's about 15% of patients and they'd try something else if that happened. 

My discussion with gp will be around side effects and also whether dietary and exercise changes could help. I have to admit my diet is the wrong side of atrocious


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## Paul Bromley (23 Mar 2016)

Hi Vickster ,

I’m on ACE inhibitors.

I had a heart attack and cardiac arrest. Total shock, out of the blue etc. Been cycling years

The put me on a blanket set of drugs, Statins, Diuretics, ACEi and Betablockers

Didn’t have high BP or high cholesterol before, infact I was prone to postural hypotension due to cycling

Initially I wasn’t functioning. BP as low as 95/57, falling over at every opportunity.

GP withdrew the diuretics and over time the ACEi, Beta blockers and Statins have been reduced to their respective lowest therapeutic doses


I returned to biking after a year off, not due to any problems but purely due to promise to wife not to cycle for a year

Luckily, on my return to the saddle I have been cycling with no problems doing just over 2000miles last summer commuting to work. (30mile round trip)

The only side affect I can say I notice is that the statin seem to make my toes feel like they are clawing in the middle of the night

Back to the cycling, I put in a 15 year plus personal best last summer which was a really tonic for me

Clearly some part of my heart died when I had heart attack, and the meds must affect me but I can’t say my cycling shows it up

All I can offer is that side affects may be a function of dosage or I am just lucky
All the best


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## martint235 (23 Mar 2016)

Thanks for that. That's re-assured me somewhat


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## vickster (23 Mar 2016)

@Paul Bromley I think you mean @martint235 

My BP is actually lower (typically around 110/70)


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## martint235 (23 Mar 2016)

3 years ago mine was about the same. I'm not sure how much there is in not cycling much last year and it being a stressful year. Will discuss with doc


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## fossyant (23 Mar 2016)

Stress is a big cause of high BP. Maybe keep it under review.


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## Fab Foodie (23 Mar 2016)

Milk contains a natural ACE inhibitor .... not a lot of people know that ....
I'd give it a go. If you have side effects then go back to the Doc. Far better to have ACE inhibitors than Beta Blockers as I take .... and 2 different Statins. I can do plenty of miles on my meds without issue.


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## Paul Bromley (23 Mar 2016)

Interesting my average BP taking over many readings and months is 110/69. So the same as yours


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## Paul Bromley (23 Mar 2016)

Sorry Vickster. Did it again !


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## Paul Bromley (23 Mar 2016)

Just off topic now - the milk. Does it have to be full fat for the ACEi effect. I use the stuff that is water passed over a cow er I mean skimmed


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## Fab Foodie (23 Mar 2016)

Paul Bromley said:


> Just off topic now - the milk. Does it have to be full fat for the ACEi effect. I use the stuff that is water passed over a cow er I mean skimmed


It's in the protein fraction so I think it should still be present in Skimmed -milk .... though it's a long while since I worked on that project ....
There's a lot of heavy papers on the internet.


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## Paul Bromley (23 Mar 2016)

Thanks Fab Foodie. I'm no chemist so I'll give the scientific papers a miss


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## martint235 (24 Mar 2016)

I believe the cough does go if you stop. 

I'm hopefully not coming across as stroppy, I respect the cardiologist and his opinion. I also realise my GP isn't a heart expert but between the two of us we are experts in me. 

The issue or worry to me is I cycle long distances. My heart delivers oxygen on demand to the muscles and I'm just wary of anything that affects that function


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## vickster (24 Mar 2016)

I'm sure many of the Novo Nordisk pro team are taking BP meds and others, maybe do some research around them?


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## slowmotion (24 Mar 2016)

I've been on an ACE inhibitor (Ramipril) for four years, as well as statins and other cholesterol reducing drugs. I ride about four and a half thousand miles each year, mainly commuting. I've had absolutely no adverse side-effects at all. I used to be opposed to long-term medication but I have no objections at all to it now. If you have problems with the drugs that you are prescribed, your GP can find alternatives, or you yourself can decide to stop. Personally, I would give it a shot and see how it goes. Good luck.


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## PMarkey (24 Mar 2016)

Also been on Ramipril for years (since 2003 ) plus Beta-blockers (Bisoprolol) since 2007 and have been riding Audax for the last 4 years and have had no problems riding distances up to 1400 km , this year I'm going for a RRTY , SR and riding the 2100 km Wild Atlantic way Audax in June so for me at least , the medication has caused no obvious problems . I did rather foolishly stop taking the tablets a few days before the Old 240 400km Audax in 2014 as I thought they might be effecting my performance and promptly passed out at the side of the road whilst climbing towards Yad Moss from Alston  though that was the Beta blockers , never a good idea to stop taking them without some sort of medical guidance.

Paul


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## martint235 (25 Mar 2016)

Thanks for all the advice. So it appears I have nothing to lose if I manage to avoid the side effects in particular the cough. 

Don't suppose it aids with weight loss?


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## djmc (27 Mar 2016)

Round here (France) Irbesartan alias Aprovel seem to be the antihypertensives usually used. They work in a slightly different way (they are angiotensin blockers rather than inhibitors) and don't seem to exacerbate a cough in the same way. I take them and don't have any side effects.


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## martint235 (3 Aug 2016)

So a quick update. I agreed to go on Ramipril. I'd been on it about two weeks before my first big bike ride. I got 80 miles in and everything cramped up and I had to bail. On subsequent rides I had to carefully manage the cramps until I hit on the bright idea of taking painkillers at the half way stops which isn't ideal but was a surprisingly effective workaround. 

Anyway I had my review with the cardiologist and I'm now on Candesartan. There was no argument, I explained the cramps and he switched me straight away. Got a century on Saturday and will see how it goes


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## Yorksman (27 Aug 2016)

ACE inhibitors contain a modified molecule found in Pit Viper Venom. This venom from this snake will cause its prey to collapse because of the sudden drop in blood pressure. I've been on them for 14 years now and have developed a great appetite for the humble dormouse.

The problem with uncontrolled high blood pressure is that it can damage your heart wall. It loses it's elasticity and doesn't eject enough blood at each contraction, with a result of lack of oxygenation. Prolonged high BP can be serious so don't just think you can live with it.


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## Yorksman (27 Aug 2016)

martint235 said:


> I'm hopefully not coming across as stroppy, I respect the cardiologist and his opinion. I also realise my GP isn't a heart expert but between the two of us we are experts in me.
> 
> The issue or worry to me is I cycle long distances. My heart delivers oxygen on demand to the muscles and I'm just wary of anything that affects that function



Ask your GP for a referral for a 'GP Echogram'. A cardiologist would get these done as standard but GPs can order them too. The report by the technician will give the GP all the info he or she needs and recommend further action or referral to a cardiologist if required.

All it is is an ultrasound recording of your heart beating, like those fetal monitors, some cold gel and a soft pad but it will tell you if your heart is pumping enough blood with each beat.


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## martint235 (28 Aug 2016)

Yorksman said:


> Ask your GP for a referral for a 'GP Echogram'. A cardiologist would get these done as standard but GPs can order them too. The report by the technician will give the GP all the info he or she needs and recommend further action or referral to a cardiologist if required.
> 
> All it is is an ultrasound recording of your heart beating, like those fetal monitors, some cold gel and a soft pad but it will tell you if your heart is pumping enough blood with each beat.


Yep had one of those. That's what finally showed up that the irregular heartbeat had been a temporary thing.


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