To Go On an Angoitensin Receptor Blocker or Not

[cbdheartman]

Dear Friends,

It has been a while. Brief background, last August I had surgery to repair my aortic root aneurysm and spare my BAV. I am doing great. I've met with the wonderful Dr. Dietz at Hopkins and he and his staff are suggesting that I go on an Angoitensin Receptor Blocker, specifically Avapro. My blood pressure is quite good. I occasionally will see it at the 130 on the systolic, but basically when I take myself I am somewhere in the 100-120 range for systolic.

It seems that the recommendation is for two reasons: 1) to maintain a regularly low blood pressure; and 2) because there seems to be some research that this drug has prophylactic properties in Marfan and Loeys-Dietz patients. There seems to be some research indicating that these drugs block receptors in the vessels that lead to expansion.

I was wondering if anyone else has faced this question and what your thoughts are on going such a drug. I'd prefer not to go on medication if possible and I wonder if going on this is worth it. The science seems unconfirmed. At the same time, if this does help prevent what is unlikely, but still possible dilation further up the aorta then perhaps it is worth it.

Any advice or help you can give me would be worth it. Maryka I also know I owe you an e-mail on this very topic!

 

[Ross]

For what it's worth, it didn't work for me, but it has worked for many others. I would suggest that you do take it. Why take unnecessary chances?

 

[Lionheart]

cbdheartman,
Before surgery I was on Ace inhibitors, Calcium channel blockers, and beta blockers. All of them had miserable side effects for me. After surgery my cardio eventually put me on Benicar an angiotensin II receptor blocker and it has done a good job of lowering my BP with no apparent side effects. It is one BP med. that I don't mind taking.
John

 

[Maryka]

Hi CDB!
As I told you recently, the idea is NOT to lower your blood pressure, but to make sure when you heart is pumping a lot due to exertion/exercise that it is not hitting your aorta walls with great force, thus causing (or increasing size of any) aneurysms. Long before Losartan was discovered to reverse some damage in Marfan people, beta blockers were statisticly shown to prevent or slow the growth of aortic aneurysms. All people today are routinely prescribed beta blockers when an aortic aneurysm is discovered. (My internist put me on them the day my aneurysm appeared on a routine chest xray in 1990.)

Some people have trouble tolerating some beta blockers. If I were you, I would start with the drug Dr. Dietz prescribed and switch to another BB if that one causes you problems. People with aneurysms or propensity to develop aneurysms (that is you, hint hint) may be prescribed higher levels of BBs so they can exercise more. The idea is to keep your pulse rate low (and the intensity of the blood flow low) during exercise. Having good BP readings has nothing to do with why you should take a BB in your situation.

 

[epstns]

I can't add anything regarding aneurism control, but I've been taking Avalide (an ARB) to control hypertension for a number of years. No side effects noted, and it works. Seems like a low-risk med to try. It does somewhat limit my exercise ability, but for me it is a small price to pay for controlling what would otherwise be dangerously high blood pressure.

 

[cbdheartman]

Maryka,

One of the reasons the PA for Dr. Dietz told me to go it was because they want my BP to be low. So it seems like one of their reasons is lower BP. But is there some tissue related piece here that I am missing. I think I am going to at least try it, but my BP is really quite good. Last night I was at 90/40 or something like that! Before that 105/60.

 

[Ross]

In simple terms, it's to prevent your heart from working harder then it has too.

 

[a4wanman]

I agree with Ross. I was initially but on a calcium blocker (Procardia / nifedepine). Cardio said it was so much the blood pressure readings, but so the heart did not have to work harder. I'm not a heart specialist, but my LV size stopped increasing after starting the medicine. My aorta is 4.5 cm by echo. I don't mind the medicine if it keeps the aorta from expanding further until it's surgically repaired.

Spent 9 days in Emory this past January with a bacterial infection. Two days after being admitted, I had a v-tach episode for about 10-15 seconds. I was then started on metoprolol (beta blocker) in addition to the Procardia.

Scott

 

[colsha]

Just to throw my 2 cents worth into the mix, I just had my 6 wk post-op consultation with the Cardiologist.
He allowed me to cease (immediately) the magnesium supplements and the Amiodarone which I'd been prescribed whilst in hospital to combat/help Atrial Fib (one short bout) - which worried the nursing staff much more than me.

Prior to the op I was on 30mg of Atenolol (1 tablet) in the morning and 5mg (1/2 a tablet) of Amlodipine (Norvasc) in the evening.

He cancelled the Amlodipine and changed it to 1 x 8mg tablet of Atacand (an ARB) as he said that there is some evidence that it is beneficial (on a cellular level) for those with Connective Tissue Disorder (and/or a predisposition for developing aneurysms).

I've now taken three doses of the Atacand and feel no different, but if the benefit is internal, I don't suppose I would.

So, overall my BP's pretty good (115/70) and pulse normally now sits between 60 and 70 bpm (much lower than pre-op).

Col

 

[Maryka]

Hi, again, CBD! We seem to be going around in circles here. The recommended medication has NOTHING TO DO WITH YOUR FINE BLOOD PRESSURE! I disagree with what a few others have said here about the recommended medication would not put strain on your heart, also. I have been to many workshops on connective tissue problems and talked to many people with a history of aneursyms but who had dandy blood pressure readings. The reason a medication normally given to people with high blood pressure is given to people who have/have had an aneurysm is to prevent further growth of the aneurysm/new aneurysms.

At one point Dietz's staff doubled my beta blocker. They told me the reason was to encourage me to exercise more, not to lower my blood pressure. My aneurysm DID stabilize for many, many years. Then, after I went on Cozaar/Losartan, the aneurysm seemed to shrink just a little bit. (Sadly my heart valve continued to deteriorate.)

We all know you love to exercise, CBD. Current medical indications are that you can continue to exercise without new aneurysmal growth IF you take the medication you were prescribed.

 

[Maryka]

Correcting that wonky sentence which said: I disagree with what a few others have said here about the recommended medication would not put strain on your heart, also.

I disagree with all of those (including the very knowledgable Ross) who told you the medication is to protect your heart. In this case, it is to keep you from getting more aneurysms. (I believe they fixed your aneurysm, right?) Or, if you stilll have that first aneurysm, it is to stabilize its growth.

Why don't you call Dietz's office? He or his assistants can explain it to you. IT HAS NOTHING TO DO WITH YOUR BLOOD PRESSURE, but is highly recommended to save your aorta.

 

[kbheart]

I've been on Cozaar for 3 1/2 years now. I never had high blood pressure but did have an aneurysm and a couple dissections (possibly marfans). No new aneurysms and dissections since starting the drug. I haven't had any side effects, either. My cardiologist even wanted my kids to take it since they have a 50% chance of the same disease. Good luck!

 

[BarbJean]

Kris, It is encouraging to read your thoughts on Cozaar(Losartan). My son will be having aortic surgery soon. Today, he is starting the Losartan in addition to his atenolol. I am hoping he does not have alot of side effects. He has Marfan Syndrome also.

 

[cbdheartman]

Thanks. Yes, I get the sense that the recommendation is two-fold -- one to reduce the pressure and two because of the prophylactic effects it has on the tissue. My valve was not the problem, so the aneurysm was fixed and the valve spared -- tighter than it has ever been. I can my heart beat so much louder than before!