Advice Please, Sqad?

[gness]

Afternoon, Sqad. I'd appreciate your opinion please.

Female patient with recently diagnosed atrial fibrillation taking, since March, Apixaban 5mg twice daily. Bisoprolol 2.5 mg twice daily.
Last check up showed BP a bit high. (White Coat?) Don't know the figures. Takes her own BP at home and it always runs around 140/72.
GP now wants to add Ramipril to lower BP.

I think this is a slight overkill. Patient is not keen on side effects of Ramipril. Should she agree to take it will the bottom figure not become too low and if so what effect would that have on her.

Thank you, Gx

[Sqad]

LOL.........matter of opinion here.
Her atrial fibrillation is almost certainly secondary to her hypertension (High Blood pressure).
So the question is........is her BP of around 140/72 low enough ?
Depends who you ask......if you ask a Cardiologist, he would say, that it is still not low enough........if you ask sqad, he will say, that it IS low enough and no added hypotensive drugs needed.

Ramipril is a standard addition and a reasonable shout, if your friend wants to go down that route.

I understand your description of "overkill" of which I have some sympathy .

My advice is to take the Ramipril addition and see how it goes......if she gets side effects then she can stop taking it.

That is my opinion.

[gness]

Thank you, Sqad........ apart from lowering BP too much I have seen the horrid side effects of Ramipril..... and of course the possibility of kidney damage. There would be a follow up blood test to check for that after two weeks I understand.

All will be mulled over and considered but I do appreciate your input....... Gx

[Sqad]

O.K

[Peter Pedant]

blimey this is standard -
about 30 % of the population is in this category

I take nebiv to get the wrist pulse betow 100
and religiously taken the apix
and sort of take whammy when I feel OK
( IS meant to have a lower mortality effect )

and dont let onto the doctor

a lot of olds feel that the onset of atr Fib ( 30% over 70) is a visible sign of the Clock Running Down and will Never Be the Same

and I say o god try ca colon at age 47