ACE Inhibitor versus an Angiotensin Receptor Blocker

Ever since I was diagnosed with Left Ventricular Hypertorphy secondary to my kidney disease, I was put on Carvedilol (6.25 mg twice daily) and Ramipril (5 mg once daily). My Blood Pressure was controlled really very well. My normal BP currently is between 90/60 to 100/70. Many dialysis technicians are worried about my low BP, especially those who see me for the first time (usually happens when I am on a holiday!)

When I went to my cardiologist, a few years back, he said, "Lower the better" when I asked him about my unusually low BP. For my heart, undoubtedly, lower was better! Within a year of starting daily nocturnal home hemodialysis, my Ejection Fraction (a measure of the function of the Left Ventricle of the heart) bounced back to normal! My Carvedilol & Ramipril dose was reduced to half about a year back due to the low-ish BP.

For the last few months, I have been having recurrent coughs. It usually is dry. I try a ton of home remedies to no avail. I then take a course of antibiotics and it seems to go away only to return in a couple of months.

During my last consultation with my nephrologist, I told him about the recurrent coughs. He immediately asked me to stop Ramipril. My BP went up and I had these bouts of stress and headaches. I called my nephrologist and he suggested I take Coversyl. I blogged about this here. In a comment on that post, Dr. Avinash Ghimire (I am presuming he is a nephrologist) suggested that Coversyl was very similar to Ramipril (both are what they call 'ACE Inhibitors'). The thinking, I assume was that Coversyl would continue to cause cough if the cough was due to Ramipril. He suggested using an Angiotensin Receptor Blocker (ARB), another class of anti-hypertensives which do not have the side effect of cough.

This morning, I checked on this with Dr. Anuj Kapadia, my classmate at HPS and now a Cardiologist at Care Hospital. He confirmed this and suggested that I take Losartan, an ARB. Both these classes of drugs (ACE inhibitors and ARBs) are considered really good for BP control with other good effects as well. But each of them has a set of possible side effects as well. So, the therapy really needs to be individualized.

I will check with my nephrologist about this one last time and then start off on Losartan. It has a side effect of possible hyperkalemia (increasing the serum potassium levels) and I need to be a little careful about my potassium since I take a phosphorus supplement that has potassium in it!

Yes, it is a tough life with CKD!!


Avinash Ghimire said…
I'm glad you got help from your friend.
if you don't mind me asking,where do you get your PD solution from and how much does it cost? overall how much are you spending per month for therapy including and excluding medications?
and yes,you are right, I'm a Nephrologist.
take care
Madras Hash said…
Years ago my mother was having a dry cough. She suffered it till a endocrinologist looked at her cocktail of medications and said that (my memory is a bit hazy here) that it was a known side effect of Ramipril (beta blocker?) and that switching to an earlier generation of a beta blocker (?) would clear the cough. It did.

It is a different issue that the dry cough is back, and no one seems to have any bright ideas.
Kamal D Shah said…
Hello Dr. Ghimire,

I am not on PD actually. I am on daily nocturnal home hemo. I was on PD for six years from 1999 to 2005. I used to get my PD fluid from Baxter which has a local distributor. Currently PD fluid from Baxter costs about Rs. 18,000 monthly for three exchanges every day.

Can you please send me your email address (mine is I can send you details about my expenses by email.

Thanks for stopping by!

Bala said…
I used to take Enam(ACE) which caused me dry cough, then doctor switched me to Losarton(ARB) - cough gone, potassium did not go up