Expert: Dr. Ravindra Bhaskar Ghooi - 5/7/2007

Question
what can be the rationale of losartan +ramipril combination. Is is more effective than newer molecules like micardis or avalide ? In India, sometimes, a patient on losartan 100 with HCT not able to control BP then combination losartan +ramipril + hct given rather than starting new arbs recently available

Answer
HI Preet,
When blood pressure is not adequately controlled with a single agent, we prefer to add another rather than go on increasing the dose. This reduces incidence of side effects which may be seen on increasing the dose. Ramipril is an ACE inhibitor and losartan is an angiotensin antagonist, they both work on different stages of the same pathway (quite like sulpha and TMP combination) have synergistic effects and low incidence of side effects. Newer agents may be better (in some cases) but increase the cost of treatment very significantly hence such combinations are prefferred.
Ravi Ghooi