AboutDomenic Sica Expertise All aspects of hypertension as well as any consideration in drug therapy for the management
of hypertension.
Experience Heavily published in the area of drug therapy in hypertension and renal disease. Primary management physician for a large multi-state referral practice for diagnosis and management of complex hypertension
Organizations Multiple including the American Society of Hypertension, International Society of Hypertension, American Society of Nephrology, American Heart Association, American College of Clinical Pharmacology amongst others.
Publications Over 250 publications (see PubMed)
Education/Credentials Board certified in internal medicine, nephrology, clinical pharmacology, and hypertension
Awards and Honors Multiple awards as clinical and/or teacher of the year.
Question QUESTION: I apologize for not knowing how to followup on my recent question to you regarding Vascar. Allow me to remind you of the pertinent facts: reduced to 25MG Toprol XL from 100MG (daily) and placed on 2.5MG (daily) of Vascar. I'm considering asking my physician to switch me to an ACE inhibitor after doing a lot of research on the Internet. I've come up with three possibilities: Quinapril, Lisinopril and Enalapril. I'm wondering what your opinion is regarding this switch and if I've chosen the possibilities (among several options) that are the safest and most efficacious. I very much appreciate the fact that you make yourself available in this manner on the Internet; if you require more information, please let me know.
ANSWER: It is hard to predict ahead of time how well a new blood pressure medication class will affect your blood pressure. Two thoughts come to mind: why did you physician chose the drug class that he did (you would have to ask him) and whether what you are on is controlling your hypertension. At a minimum you can talk to him/her physician about these issues.
Regards,
Dom Sica, M.D.
---------- FOLLOW-UP ----------
QUESTION: My Dr. is a family physician, for all I know he chose Vascor because it works for other patients. I have no medical problems at all (other than hypertension) and he wanted to get me off 100MG Toprol because my BP was too low, I was very fatigued by mid-afternoon and it was interfering with my sleep at night. 5.0 MG Vascor was too much (with the 25 MG Toprol), BP was too low; I don't like calcium channel blockers, too much bad "press" on the Internet, this drug scares me. My BP is absolutely normal or below (average 115/75) with 2.5 MG Vascor and 25MG Toprol; I'd like to try an ACE inhibitor because I've read they're safer and better for the arteries. My question was: are Quinapril, Lisinopril and Enalapril SAFE? I know they'll be effective; my BP is easy to control.
Answer All ACE inhibitors (including the three you list) are for the most part safe and effective. There are still some " potential" side-effects with these particular medications as you are no doubt aware from your research. If they work and lower your pressure then the switch would have been fine.
As an FYI the "scare" with calcium-channel blockers is now several years old and repeatedly shown to have never been the case in the first place. Unfortunately, the original scare has never been rescinded on the Internet; thus, I do not believe you were in any sort of danger from having been on Vasocor.
