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I don't see how an ARB can work if an ACE doesn't!

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I tried an ACE inhibitor (Ramipril) but it didn't work to lower my blood pressure. I then tried Altace HTC (which I think is just ramipril with a thiazide diuretic). That worked - but I think it's giving me gout. So now I'm trying Olmetec (an ARB) but after a week my blood pressure is still high (140 / 90) so I don't think it's doing anything for me.

So my question is: If an ACE inhibitor does nothing to reduce my blood pressure, then how likely will it be that an ARB will be any different? They both function on the premis that my kidneys are producing too much angiotensin I, and they try to limit my body's utilization of angiotensin I. So I don't see how an ARB can work if an ACE doesn't.

Altace HTC does work to lower my pressure (keeps it a rock steady 120/80). But could that all be due to the thiazide diuretic by itself? Like I said, I'm stopping the Altace HTC because it's quite likely that the thiazide is causing me to have gout.

And a side question: Does the effectiveness of an ACE inhibitor match it's ability to give you a cough or dry throat? In other words, the more effective an ACE inhibitor is for you at reducing your blood pressure, the more likely you are to experience the side effect of a cough or dry throat. ? I ask because I had almost no cough side effects when I was taking ramipril or altace HTC.

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replied March 21st, 2011
High Blood Pressure and Hypertension Answer A21094
Hi, welcome to the ehealth forum and I am glad to help you out.
Your concern seems to be regarding the appropriate drug options to treat hypertension as the diuretics which were previously effective have to be stopped in view of gout problem. And you have made a mention that ACEI and ARBs don't seem to be effective in your case.
It is reasonable to consider trial rotation of a patient through each of the 4 classes of anti-hypertensive to discover the class giving maximum BP reduction with the minimum of side effects. Typically, only 2/3rds of mildly hypertensive patients will respond to a drug chosen at random from the 4 classes.
Because of the convergence of action of the classes (ACEI/Beta-blocker through renin - angiotensin system and diuretic/CCB independent of it) the choice is in practise reduced to:

ACEI or Beta-blocker VERSUS CCB or Diuretic ….. the 'ABCD' Rule

The practice is to start any drug at a low dose and only increase the dose if a drug is partially effective and well tolerated.

If a drug is ineffective or partially effective and/or not well tolerated then:

-EITHER the drug is changed
-OR Second drug is added from another pharmacological class
Additions are based on possibility of either complementary action or countering the reflex action of the first drug. From the 'ABCD' rule choice is simplified to ACEI or Beta-blocker PLUS CCB or Diuretic.
In your case the option is thus to shift to CCBs plus ACEI or Beta-Blocker.
You can discuss the option with your personal physician and then only effect any changes.
Hope this helps. Take care.
Note: This post is not to emphasise final diagnosis as the same cannot be made online and is aimed just to provide medical information and no treatment suggested above be taken without face to face consultation with health care professional.

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