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Ask Dr. D. Love Your Own Question
Dr. D. Love
Dr. D. Love, Doctor
Category: Medical
Satisfied Customers: 18777
Experience:  Family Physician for 10 years; Hospital Medical Director for 10 years.
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knowing that Ramipril helps to widen the blood vessels and

Resolved Question:

knowing that Ramipril helps to widen the blood vessels and that it works with the beta blockers. I have had an increase in water retention since I was taken off these. I am also on three 40 mg tablets daily which my doctor has now increased to four. I am rather concerned at the continued exclusion of ramipril. Pkease advise
Submitted: 3 years ago.
Category: Medical
Expert:  Dr. D. Love replied 3 years ago.
Ramipril, and all ACE inhibitors, actually also works to cause a mild diuretic effect. The main impact of angiotensin is to constrict blood vessels, so that inhibiting the formation of angiotensin (or more accurately, the more potent form of angiotensin) will lead to dilation of blood vessels. However, a secondary effect of angiotensin is to stimulate aldosterone release from the adrenal glands, will causes the kidney to retain fluid and sodium. By inhibiting the formation of angiotensin, there also is a lesser amount of aldosterone, creating a mild diuretic effect.

Therefore, it is not surprising that someone in whom the Ramipril is stopped will develop an exacerbation of fluid retention.

However, it is not clear from what you describe why your doctor stopped the Ramipril. Did your doctor comment upon why it was stopped?

Customer: replied 3 years ago.
My doctor took me off the ramipril some months ago after saying that I didn't need it because my blood pressure was o .k. My wife who was with me at the time expressed her concern about this as She knew it worked with the heart tablet and that it wasn't just for blood pressure. He assured her it was fine.
Customer: replied 3 years ago.
I Will be seeing my doctor again tomorrow Can I insist that I be put back on Ramipril
Expert:  Dr. D. Love replied 3 years ago.
Have you had an assessment for congestive heart failure?
Have you had an echocardiogram?

Customer: replied 3 years ago.
Yes to both questions
Expert:  Dr. D. Love replied 3 years ago.
What was the result of the evaluation?
Have you been diagnosed with congestive heart failure?

Customer: replied 3 years ago.
Diagnosis: 1 . Ischaemic heart disease with previous myocardial infarction in 2000 .
2. Chronic heart failure
(ejection fraction 25 per cent.
3. 5.7 cm infrarenal andominal aortic aneurysm (Evar August 2011 )
Expert:  Dr. D. Love replied 3 years ago.
Thank you for the additional information.

It is generally not effective to simply insist that a doctor prescribe a medicine. It is typically not a good position to ask a doctor to prescribe a medicine against their better judgement. It is better to provide a rationale for why the doctor should judge that the medicine should be prescribed. In your case, it sounds like the better rationale for why the Ramipril should be prescribed is because of the chronic heart failure with an ejection fraction of 25% along with the fluid retention and ascites that has developed since the Ramipril was stopped. In addition to treating high blood pressure, Ramipril (and other ACE inhibitors) treat heart failure and improve ejection fraction. So, the issue may not be not whether the blood pressure will be good off the Ramipril, but rather the issue is that the heart failure may be getting worse off the Ramipril causing the fluid retention and ascites.

I think that there will be greater likelihood that the doctor will resume the Ramipril is these factors are expressed to your doctor, rather than simply insisting that the medicine be prescribed.

Dr. D. Love and other Medical Specialists are ready to help you
Customer: replied 3 years ago.
Dear Dr Love

I will take your advice when I speak to the Doctor tomorrow. With grateful thanks for your help.

Roy Barry
Expert:  Dr. D. Love replied 3 years ago.
You're welcome. I hope that everything goes well.