Experience 35 years of experience in the field of nephrology & hypertension. Emeritus Professor of clinical Medicine at a major medical school and director of Nephrology & Hypertension at a university affiliated medical center.
Question Lisinpril side effects are shown to include possible stomach pain. Can you explain if this effect of Lisinopril might be caused by reduction of blood flow(ischemia) to the stomach. In the past, I have seen a contraindication for Lisinopril and renal artery stenosis, which indicates it may also not be good for people with peripheral artery disease or for people with arteral schlerosis (sp?) which may extend to stomach blood supply.
Answer Dear Eric,
Lisinopril is such a great medication that I take it myself!
Lisinopril and ALL OTHER ACE inhibitors work by inhibiting the formation of a substance called angiotension II in the lung. Angio II is one of the most potent vasoconstrictors known. Angio II, then, makes the blood pressure go up and many patients with hypertension are very sensitive to its effects. Lisinopril and all other ACE inhibitors reduce the amount of angiotension II formed and, therefore, are usually effective in lowering blood pressure.
The FDA regulations require drug manufacturers to list ALL COMPLAINTS submitted while a patient is taking a medication during clinical studies. That is why the list of side effects looks like the Manhattan phone book. Most drug manufacturers add a list of complaints that reach statisical significance. That list is the real side effect profile of a given medication. For ACE inhibitors the important problems are, cough which occurs in about 5-10% of the patients; A severe allergic reaction can occur that rarely can effect the bowel wall and secondarily cause abdominal pain. This "anaphylactic" reaction is very rare as well.
You mentioned problems with use of the drug in the presence of vascular narrowing to the renal arteries. This is a specific but potentially serious problem with ACE inhibitors. Angiotension II, it turns out, has a unique and complicated action upon the filtering unit of the kidney. The net effect of this action is to maintain and facilitate filtration by the kidney in states of low renal blood flow. These situations occur as a consequence of dehydration, arteriosclerotic narrowing of the renal arteries (the effect you mentioned) or diffuse vascular disease within the kidney. Ace inhibitors, by reducing the effect of angioII, further reduce renal blood flow and can precipitate kidney failure. This effect is common and watched for by the prescribing physician by serially monitoring kidney function tests and modifying the dose or discontinuing the drug if the effect is seen. It is completely reversible. It also is an early tip off to renal vascular disease, a common and occasionally curable cause of high blood pressure.
The abdominal pain issues, if they occur (and I have never seen them) are usually secondary to a precipitous fall in blood pressure, possibly aggravated by intestinal vascular disease. The effect is not unique like it is within the kidney. The intestines have a huge blood supply and to cause vascular (ischemic) pain, the disease has to be enormous and very widespread. This effect would not be a unique problem with ACE inhibitors but would occur with any medication that lowers blood pressure. The leg issues are analogous. In both cases, the vascular tact would need be be imaged and the respective vascular tree operated upon. The blood pressure would still need to be treated and the same principals of BP control would be just as important.
I apologize for the complicated answer but the question involves complicated physiology. I hope it make some sense to you.
The bottom line is that lisinopril is a very safe and usually effective medication and I wouldn't hesitate to take it.
Please feel free to follow up if you wish. I may have generated more questions.
