Does lisinopril cause weight gain. What are the potential side effects of lisinopril. How does lisinopril affect fluid retention. Can lisinopril lead to angioedema. What are the signs of angioedema in lisinopril users. How to recognize and manage lisinopril-related side effects. Who should avoid taking lisinopril.

The Relationship Between Lisinopril and Weight Changes

Lisinopril, a widely prescribed angiotensin-converting enzyme (ACE) inhibitor, has been a subject of interest regarding its potential impact on body weight. Clinical studies conducted by the manufacturer have shown that lisinopril does not directly cause measurable weight gain or loss. However, it’s crucial to understand that certain side effects associated with this medication may indirectly influence weight or create the appearance of weight changes.

Fluid Retention and Perceived Weight Gain

While lisinopril itself doesn’t cause weight gain, it can lead to fluid retention in some patients. This side effect may manifest as swelling in the feet or ankles, potentially giving the impression of weight gain. It’s important to note that fluid retention could be indicative of kidney problems, which can be exacerbated by lisinopril use.

Can fluid retention from lisinopril be mistaken for weight gain? Yes, the swelling caused by fluid retention can create the appearance of weight gain, even though it’s not actual fat accumulation. If you notice sudden or unexplained swelling, especially in your extremities, it’s essential to consult your healthcare provider promptly.

Lisinopril and Congestive Heart Failure

Patients being treated with lisinopril for congestive heart failure may experience rapid weight gain as a symptom of their underlying condition rather than a direct effect of the medication. This weight gain is often due to fluid accumulation in the body, a common complication of heart failure.

What should you do if you experience sudden weight gain while taking lisinopril? If you notice a rapid increase in weight, particularly if accompanied by symptoms such as difficulty breathing, fatigue, or reduced urination, contact your healthcare provider immediately. These could be signs of worsening heart failure or other serious complications.

Understanding Angioedema as a Potential Side Effect of Lisinopril

Angioedema is a serious allergic reaction that can occur in some individuals taking ACE inhibitors like lisinopril. This condition involves swelling of the face, lips, tongue, throat, genitals, or other parts of the body. It’s a potentially life-threatening side effect that requires immediate medical attention.

Recognizing the Signs of Angioedema

Angioedema can manifest in various ways, and it’s crucial to be aware of its symptoms:

• Swelling underneath the skin, which may be painful or burning
• Hives or itchy rash
• Coughing, wheezing, or shortness of breath
• Irritation in the eyes and nose
• Stomach pain

How quickly can angioedema develop after starting lisinopril? Angioedema can occur at any time after beginning treatment with lisinopril, even after long-term use. It’s crucial to remain vigilant and seek immediate medical help if you experience any symptoms of angioedema, particularly swelling of the face, throat, or tongue.

Who Should Avoid Taking Lisinopril?

Certain individuals should not use lisinopril due to increased risk of adverse reactions. These include:

1. People with a history of angioedema or allergic reactions to ACE inhibitors
2. Individuals with hereditary or idiopathic angioedema
3. Pregnant women, especially in the second and third trimesters

It’s crucial to inform your healthcare provider about all your medical conditions, including any history of airway surgery, and all medications you’re currently taking before starting lisinopril treatment.

Managing Side Effects and Monitoring Your Health on Lisinopril

While lisinopril is generally well-tolerated, it’s important to be aware of potential side effects and monitor your health closely while taking this medication. Regular check-ups with your healthcare provider can help ensure that the medication is working effectively and not causing any adverse reactions.

Tracking Your Weight and Fluid Retention

Keeping a log of your weight and any noticeable swelling can be helpful in identifying potential issues early. If you notice sudden weight gain or persistent swelling, especially in your ankles or feet, inform your doctor promptly.

How often should you weigh yourself while taking lisinopril? It’s generally recommended to weigh yourself at the same time each day, preferably in the morning after using the bathroom and before eating or drinking. This consistency can help you and your healthcare provider track any significant changes more accurately.

The Importance of Proper Dosage and Adherence

Taking lisinopril as prescribed by your healthcare provider is crucial for its effectiveness and to minimize the risk of side effects. Never adjust your dosage or stop taking the medication without consulting your doctor first.

Gradual Dose Adjustments

Your healthcare provider may start you on a lower dose of lisinopril and gradually increase it to find the optimal dosage for your condition. This approach can help minimize side effects and allow your body to adjust to the medication.

What should you do if you miss a dose of lisinopril? If you forget to take a dose, take it as soon as you remember. However, if it’s almost time for your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Never take a double dose to make up for a missed one.

Lisinopril Interactions with Other Medications and Substances

Lisinopril can interact with various medications and substances, potentially altering its effectiveness or increasing the risk of side effects. It’s crucial to inform your healthcare provider about all medications, supplements, and herbal products you’re taking.

Common Interactions to Be Aware Of

• Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen
• Potassium supplements or salt substitutes containing potassium
• Diuretics (water pills)
• Lithium
• Aliskiren

Can you drink alcohol while taking lisinopril? While moderate alcohol consumption is generally considered safe for most people taking lisinopril, it’s best to consult with your healthcare provider. Alcohol can potentially enhance the blood pressure-lowering effects of lisinopril, leading to dizziness or lightheadedness.

Long-term Use of Lisinopril: What to Expect

Lisinopril is often prescribed as a long-term medication for managing conditions like hypertension and heart failure. Understanding what to expect during extended use can help patients better manage their health and address any concerns that may arise.

Regular Monitoring and Check-ups

Your healthcare provider will likely schedule regular check-ups to monitor your blood pressure, kidney function, and overall health while you’re taking lisinopril. These appointments are crucial for ensuring the medication continues to be effective and safe for you.

How often should you have your kidney function checked while on lisinopril? The frequency of kidney function tests can vary depending on your individual health status and risk factors. Generally, your healthcare provider may recommend testing every 6-12 months, or more frequently if you have pre-existing kidney issues or are at higher risk for complications.

Potential Long-term Benefits

Long-term use of lisinopril may offer several benefits beyond blood pressure control, including:

• Improved heart function in patients with heart failure
• Reduced risk of cardiovascular events in high-risk patients
• Potential kidney protection in patients with diabetes

Lifestyle Considerations While Taking Lisinopril

While lisinopril is an effective medication for managing blood pressure and heart conditions, combining it with healthy lifestyle choices can enhance its benefits and help manage potential side effects.

Diet and Nutrition

Maintaining a balanced diet low in sodium can complement the effects of lisinopril. However, it’s important to be cautious about potassium intake, as lisinopril can increase potassium levels in the body.

Should you avoid any specific foods while taking lisinopril? While there are no strict food restrictions, it’s advisable to limit your intake of high-potassium foods such as bananas, oranges, and leafy greens, especially if you’re also taking potassium supplements. Always consult your healthcare provider for personalized dietary advice.

Exercise and Physical Activity

Regular physical activity can enhance the blood pressure-lowering effects of lisinopril and contribute to overall cardiovascular health. However, it’s important to start any new exercise regimen gradually and with your doctor’s approval.

How soon after taking lisinopril can you exercise? It’s generally safe to exercise at any time while taking lisinopril. However, some people may experience dizziness or lightheadedness, especially when starting the medication or increasing the dose. If you experience these symptoms, it’s best to avoid intense physical activity until you’ve discussed it with your healthcare provider.

Alternative Treatments and Considerations

While lisinopril is an effective medication for many patients, it may not be suitable for everyone. Understanding alternative treatments and considerations can help patients make informed decisions about their healthcare in consultation with their medical providers.

Other ACE Inhibitors

If lisinopril causes intolerable side effects, your healthcare provider may consider switching you to a different ACE inhibitor. Other medications in this class include:

• Enalapril
• Ramipril
• Benazepril
• Quinapril

Alternative Medication Classes

In cases where ACE inhibitors are not suitable, other classes of blood pressure medications may be considered, such as:

• Angiotensin II receptor blockers (ARBs)
• Calcium channel blockers
• Beta-blockers
• Diuretics

What factors does a doctor consider when choosing between lisinopril and other blood pressure medications? The choice of medication depends on various factors, including the patient’s age, overall health, other medical conditions, potential drug interactions, and specific treatment goals. Your healthcare provider will consider your individual needs and medical history to determine the most appropriate medication.

Complementary Approaches

In addition to medication, several lifestyle modifications and complementary approaches can help manage blood pressure and heart health:

• Stress reduction techniques such as meditation or yoga
• Dietary approaches like the DASH (Dietary Approaches to Stop Hypertension) diet
• Weight management
• Limiting alcohol consumption
• Quitting smoking

Can lifestyle changes alone be enough to manage hypertension without medication? For some individuals with mild hypertension, lifestyle modifications may be sufficient to control blood pressure. However, this approach requires dedication and consistent effort. It’s crucial to work closely with your healthcare provider to monitor your progress and determine if medication is necessary.

Understanding the Broader Impact of ACE Inhibitors

Lisinopril belongs to the class of medications known as ACE inhibitors, which have been widely studied for their effects on various aspects of health beyond blood pressure control. Understanding these broader impacts can provide valuable context for patients taking lisinopril or considering it as a treatment option.

Cardiovascular Protection

ACE inhibitors like lisinopril have been shown to offer cardiovascular protection beyond their blood pressure-lowering effects. This includes:

• Reducing the risk of heart attacks and strokes in high-risk patients
• Improving outcomes in patients with heart failure
• Potentially slowing the progression of atherosclerosis

How do ACE inhibitors provide cardiovascular protection beyond blood pressure control? ACE inhibitors work by blocking the production of angiotensin II, a hormone that not only raises blood pressure but also promotes inflammation and the formation of plaques in blood vessels. By reducing angiotensin II levels, these medications help protect the heart and blood vessels from damage.

Renal Protection

ACE inhibitors have demonstrated benefits in protecting kidney function, particularly in patients with diabetes or chronic kidney disease. They can help:

• Reduce protein excretion in urine (proteinuria)
• Slow the progression of diabetic nephropathy
• Preserve kidney function in patients with chronic kidney disease

Potential Cognitive Benefits

Some research suggests that ACE inhibitors may have positive effects on cognitive function, particularly in older adults. While more studies are needed to confirm these findings, potential benefits include:

• Reduced risk of cognitive decline
• Possible protection against Alzheimer’s disease
• Improved blood flow to the brain

Can lisinopril improve cognitive function in older adults? While some studies have suggested potential cognitive benefits of ACE inhibitors, the evidence is not yet conclusive. More research is needed to fully understand the relationship between these medications and cognitive health. If you have concerns about cognitive function, it’s important to discuss them with your healthcare provider.

Future Directions in ACE Inhibitor Research

As medical science continues to advance, ongoing research into ACE inhibitors like lisinopril is exploring new potential applications and refining our understanding of their effects. Some areas of current interest include:

• Personalized medicine approaches to optimize ACE inhibitor therapy
• Potential applications in preventing or treating COVID-19 complications
• Investigating the role of ACE inhibitors in cancer prevention and treatment
• Exploring combinations with other medications for enhanced efficacy and reduced side effects

What new developments can we expect in ACE inhibitor therapy in the coming years? While it’s difficult to predict specific breakthroughs, ongoing research is likely to provide more precise guidelines for using ACE inhibitors in various patient populations, potentially expand their applications to new conditions, and develop strategies to minimize side effects while maximizing benefits.

In conclusion, while lisinopril does not directly cause weight gain, understanding its potential side effects, including fluid retention and the rare but serious risk of angioedema, is crucial for patients. By working closely with healthcare providers, monitoring for side effects, and maintaining a healthy lifestyle, patients can maximize the benefits of lisinopril while minimizing risks. As research continues to evolve, our understanding of ACE inhibitors like lisinopril and their role in managing various health conditions will undoubtedly expand, potentially offering new therapeutic opportunities in the future.

Does lisinopril cause weight gain?

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on March 22, 2022.

Lisinopril, a commonly prescribed angiotensin converting enzyme (ACE) inhibitor, does not lead to any measurable weight gain or weight loss based on clinical studies conducted by the manufacturer.

Lisinopril may cause some side effects that can cause swelling or fluid retention, which may appear as weight gain in some patients.

Lisinopril may cause swelling (fluid retention) in your feet or ankles, which may lead to weight changes or the appearance of weight changes. If you have fluid (water) retention it may be due to kidney problems which can be caused by lisinopril. If you know that you have kidney problems or take any other medicines, tell your doctor about these conditions or medicines before you start lisinopril treatment.

Patients treated with lisinopril for congestive heart failure may develop rapid weight gain as a symptom of the disease. If you experience a sudden or unexplained increase in weight, contact your doctor right away. Call your doctor if you have swelling in your legs or feet, little or no urination, trouble breathing, feeling tired or shortness of breath, coughing up blood or other side effects that bother you or do not go away.

Does lisinopril cause angioedema?

Angioedema, a swelling of your face, lips, tongue, throat, genitals or anywhere on the body may be a sign of a serious allergic reaction to ACE inhibitors, including lisinopril. It can happen at any time after starting treatment. Angioedema may lead to dangerous swelling in the tissue under the skin. This may appear as weight gain due to the swollen appearance.

If you think you are having a serious allergic reaction, get emergency help right away. Angioedema can be life-threatening if it affects your breathing. Call 911 immediately if you have trouble breathing, swelling in your mouth or throat, wheezing, itching, a rash, hives, or feel like you are going to faint.

ACE inhibitors have been associated with a higher rate of angioedema in black patients than in non-black patients.

You should not use lisinopril if:

• you have a history of angioedema or allergy related to previous treatment with an angiotensin converting enzyme (ACE) inhibitor like lisinopril
• you have a history of hereditary or idiopathic angioedema

Tell your doctor about all of your former and present medical conditions, if you’ve had airway surgery and medicines that you take before you start treatment with lisinopril.

How do I recognize angioedema?

Swelling underneath the skin may be the only symptom for angioedema, but it can be very serious in some cases. Other signs or symptoms can include:

• pain and burning in the swollen area
• hives or an itchy rash
• a cough, wheezing, and shortness of breath
• irritated eyes and nose
• stomach pain

Other medicines you may need to take to help treat angioedema are antihistamines, epinephrine (like an EpiPen), or corticosteroids (like prednisone).

Learn more: Which Drugs Cause Weight Gain?

This is not all the information you need to know about lisinopril for safe and effective use and does not take the place of your doctor’s directions. Review the full lisinopril information and discuss this information and any questions you have with your doctor or other health care provider.

References

• Slater EE, Merrill DD, Guess HA, et al. Clinical profile of angioedema associated with angiotensin converting-enzyme inhibition. JAMA. 1988;260(7):967-970.
• Lisinopril prescribing information. Drugs.com. Accessed March 22, 2022 at https://www.drugs.com/pro/lisinopril.html#s-34076-0
• Townsend R, author. Major side effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. Up to Date. Accessed March 21, 2022 at https://www.uptodate.com/contents/major-side-effects-of-angiotensin-converting-enzyme-inhibitors-and-angiotensin-ii-receptor-blockers
• Lisinopril. Side effects. Drugs.com Accessed March 21, 2022 at https://www.drugs.com/lisinopril.html#side-effects

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Medical Disclaimer

Lisinopril Oral Tablet Side Effects and How to Manage Them

If you have high blood pressure or certain heart conditions, you may be interested in learning more about lisinopril. It’s a generic prescription drug used to:

• treat high blood pressure in adults and some children
• treat heart failure in adults
• reduce the risk of death after a heart attack in adults

Lisinopril comes as an oral tablet (a tablet that you take by mouth). You’ll usually take it on a long-term basis.

This article describes lisinopril’s side effects, also called adverse effects. For more information about lisinopril, including details about its uses, see this in-depth article.

The following are just a few of the more common side effects reported by people who took lisinopril in studies. These side effects can vary depending on what condition the drug is being used to treat. Note that although these are the most common side effects, not everyone taking lisinopril will experience them.

More common side effects in people taking lisinopril for high blood pressure include:

• dry cough*
• headache*
• dizziness*

More common side effects in people taking lisinopril for heart failure include:

• chest pain
• low blood pressure

More common side effects in people taking lisinopril after a heart attack include:

• low blood pressure
• kidney problems, such as kidney failure

* To learn more about this side effect, see the “Side effects explained” section below.

Examples of mild side effects that have been reported with lisinopril include:

• weakness or fatigue (low energy)
• chest pain
• flushing (temporary warmth, redness, or deepening of skin color)
• hair loss
• dry mouth
• vision changes, such as blurry vision
• change in the way things taste or smell
• unusual sensations, such as tingling and numbness
• dry cough*
• gastrointestinal side effects*
• headache*
• dizziness*
• mild allergic reaction*

* To learn more about this side effect, see the “Side effects explained” section below.

In most cases, these side effects should be temporary. And some may be easily managed. But if you have any symptoms that are ongoing or bother you, talk with your doctor or pharmacist. And do not stop taking lisinopril unless your doctor recommends it.

Lisinopril may cause mild side effects other than the ones listed above. See the drug’s prescribing information for details.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with lisinopril, visit MedWatch.

Serious side effects that have been reported with lisinopril include:

• kidney problems, such as kidney failure
• liver problems, such as liver failure
• blood cell problems, such as low white blood cell count
• risk of fetal harm*
• high potassium levels†
• severe allergic reaction†

* Lisinopril has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see “Pregnancy and breastfeeding while taking lisinopril” in the “Warnings for lisinopril” section below.
† To learn more about this side effect, see the “Side effects explained” section below.

If you develop serious side effects while taking lisinopril, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Get answers to some frequently asked questions about lisinopril’s side effects.

Does lisinopril cause sexual side effects in men or women?

It might. In studies, erectile dysfunction (ED) was sometimes reported in men* who took lisinopril. But this side effect wasn’t common. Sexual side effects weren’t reported in women* who took lisinopril in these studies.

Note that ED can also be a symptom of high blood pressure and heart disease, which lisinopril is used to treat.

If you have sexual problems while taking lisinopril, talk with your doctor. They may investigate the possible cause and suggest ways to manage the problem. Or they may recommend switching to a different treatment for your condition.

* In this article, we use the terms “men” and “women” to refer to someone’s sex assigned at birth. For information about the difference between sex and gender, see this article.

Is it possible to develop long-term side effects from lisinopril?

It’s possible, but long-term side effects are rare. Most of lisinopril’s side effects are mild and get better quickly, either with continued treatment or soon after stopping the medication. Serious side effects of lisinopril also tend to get better quickly after stopping the drug, although some might need treatment.

If you have kidney damage with lisinopril, it’s usually reversible if you stop taking it. However, if you have liver damage caused by lisinopril, this might lead to long-term problems in rare cases.

Taking lisinopril for long periods of time isn’t known to increase your risk of developing side effects. But if you take lisinopril as a long-term treatment, your doctor will likely order blood tests from time to time to check for certain side effects, such as kidney problems.

If you’re concerned about long-term side effects with lisinopril, talk with your doctor.

Will my risk of side effects depend on the dose of lisinopril that I take (2.

5 mg, 5 mg, 10 mg, 20 mg, 30 mg, 40 mg)?

Yes, it might. As with many medications, higher doses of lisinopril are more likely to cause certain side effects. For example, you’re more likely to have low blood pressure that causes dizziness or fainting with a dose of 40 milligrams (mg) than with a dose of 5 mg.

Your risk of side effects doesn’t just depend on your dose, though. Having certain conditions can also increase your risk of side effects with lisinopril. To find out more, see “Lisinopril warnings” below.

If you’re concerned about your risk of side effects with the lisinopril dosage you’re prescribed, talk with your doctor.

Can lisinopril cause weight gain?

It’s not known to. Weight gain wasn’t reported in studies of lisinopril.

Sudden weight gain could occur if you have angioedema from taking lisinopril. Angioedema is a serious allergic reaction that causes severe swelling under your skin. But you’re more likely to notice swelling, trouble breathing, or belly pain with this side effect than weight gain.

If you take lisinopril for heart failure, unexplained weight gain could be a sign that your heart failure is getting worse. Worsening heart failure can cause fluid to build up in your body, which can cause weight gain. In this case, you’d likely also have new or worsening shortness of breath.

If you have sudden weight gain while taking lisinopril, talk with your doctor, especially if you also have other symptoms. They can investigate the possible cause.

Will discontinuing lisinopril treatment cause any side effects?

No, that’s not likely. Stopping lisinopril won’t cause withdrawal symptoms. Withdrawal symptoms are side effects you might have if you suddenly stop taking a drug that your body is dependent on. (With dependence, your body needs a drug to function as usual.)

However, stopping lisinopril will reverse its effects, which could worsen your condition. For example, if you take lisinopril for heart failure, stopping treatment could make your heart failure symptoms come back. If you take lisinopril for high blood pressure, stopping treatment could make your blood pressure increase. This may not cause symptoms, but it could increase your risk of heart attack or stroke.

If you’re thinking about stopping lisinopril treatment, talk with your doctor first.

Learn more about some of the side effects lisinopril may cause.

Dry cough

You may develop a persistent dry cough while taking lisinopril. In studies, a cough was one of the most common side effects reported with lisinopril.

A dry cough doesn’t produce phlegm or mucus. It’s sometimes described as tickly or scratchy.

What might help

If you have a cough with lisinopril, taking frequent sips of water may help ease this side effect. Cough medications don’t usually help this kind of cough.

Sometimes, a cough may gradually get better on its own as you continue to take lisinopril. But if it doesn’t, or it bothers you, talk with your doctor. They may suggest switching to a different medication.

Note that it might take a few weeks for a cough to go away after stopping lisinopril.

Gastrointestinal side effects

Some people may have gastrointestinal side effects while taking lisinopril. But in studies, these weren’t among the more common side effects reported with lisinopril.

Gastrointestinal side effects involve your stomach or intestines. They’re also known as digestive side effects. Examples include:

• constipation
• diarrhea
• gas
• nausea or vomiting

Note that diarrhea and vomiting can make you lose more fluids than usual, which can lead to dehydration. Dehydration increases your risk of low blood pressure, dizziness, and kidney problems with lisinopril.

What might help

If you have gastrointestinal side effects with lisinopril, talk with your doctor or pharmacist. In some cases, they may suggest taking an over-the-counter medication to treat the side effect. If you have diarrhea or vomiting, try to drink plenty of nonalcoholic fluids to avoid getting dehydrated.

Gastrointestinal side effects may lessen as you continue to take lisinopril. But if these side effects don’t go away, talk with your doctor. They may recommend switching to a medication other than lisinopril.

High potassium levels

Lisinopril can sometimes cause hyperkalemia, which is a high level of potassium in your blood. Hyperkalemia is usually mild and doesn’t generally cause symptoms. But if your potassium level gets too high, it can lead to serious heart problems.

Symptoms of hyperkalemia include:

• nausea or vomiting
• muscle weakness, pain, or cramps
• fatigue (low energy)
• irregular heartbeat

You’re more likely to have hyperkalemia with lisinopril if you:

• have kidney problems
• have diabetes
• take certain other medications, especially potassium-sparing diuretic medications, such as Aldactone (spironolactone)
• take potassium supplements
• use salt substitutes that contain potassium

What might help

Before starting lisinopril, be sure to talk with your doctor about your health history, diet, and other medications you take.

Your doctor will likely order blood tests to monitor your potassium levels while you take lisinopril. But if you develop symptoms of hyperkalemia at any point, tell your doctor right away.

If your potassium level gets too high, your doctor may prescribe medication to correct it. They may also recommend stopping lisinopril temporarily.

Headache

You may have headaches while taking lisinopril. In studies, headache was one of the most common side effects reported with lisinopril.

What might help

If you have headaches with lisinopril, it may help to drink lots of water and get plenty of rest. If the headaches are bothersome, ask your pharmacist to recommend a suitable pain reliever. It’s generally safe to take Tylenol (acetaminophen) with lisinopril.

Headaches may gradually ease as you continue to take lisinopril. But if you keep having bothersome headaches, talk with your doctor. They may suggest switching to a medication other than lisinopril.

Dizziness

It’s common to feel dizzy or lightheaded while taking lisinopril, especially if you stand up too quickly. Dizziness is caused by low blood pressure. It can sometimes lead to fainting. It’s more likely to happen in the first few days of treatment and after increases in dosage.

In studies, dizziness was one of the most common side effects reported with lisinopril.

You’re more likely to have low blood pressure and dizziness with lisinopril if you:

• have vomiting or diarrhea
• sweat heavily
• don’t drink enough fluids
• take diuretic medications, such as Lasix (furosemide)
• have heart failure
• have dialysis for kidney failure

What might help

If you feel dizzy or lightheaded while taking lisinopril, sit or lie down until the feeling passes. If you have dizziness when standing up, it may help to get up very slowly.

If lisinopril makes you feel dizzy, you should avoid potentially dangerous activities. Examples include driving, riding bikes or horses, and climbing ladders.

To help prevent dizziness with lisinopril, make sure you drink enough fluids. This is particularly important if you have diarrhea or vomiting, or if you sweat heavily.

Dizziness usually improves with continued treatment. But if you have bothersome dizziness that doesn’t get better, talk with your doctor. They may lower your lisinopril dosage. Or they may suggest switching to a medication other than lisinopril.

Allergic reaction

Like most drugs, lisinopril can cause an allergic reaction in some people.

Symptoms can be mild to serious and can include:

• skin rash
• itchiness
• flushing (temporary warmth, redness, or deepening of skin color)
• swelling under your skin, usually in your face, eyelids, lips, arms, legs, hands, or feet
• swelling of your mouth, tongue, or throat, which can make it hard to breathe
• swelling in your intestine, which can cause belly pain, with or without nausea or vomiting

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms. Examples include:

• an antihistamine you take by mouth, such as Benadryl (diphenhydramine)
• a product you apply to your skin, such as hydrocortisone cream

If your doctor confirms you’ve had a mild allergic reaction to lisinopril, they’ll decide if you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to lisinopril, they may have you switch to a different treatment.

Keeping track of side effects

During your lisinopril treatment, consider taking notes on any side effects you’re having. You can then share this information with your doctor. This is especially helpful when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things such as:

• what dose of the drug you were taking when you had the side effect
• how soon you had the side effect after starting that dose
• what your symptoms were
• how it affected your daily activities
• what other medications you were taking
• any other information you feel is important

Keeping notes and sharing them with your doctor will help them learn more about how lisinopril affects you. They can then use this information to adjust your treatment plan if needed.

Lisinopril comes with several warnings that are described below.

Boxed warning: Risk of fetal harm

Lisinopril has a boxed warning for the risk of fetal harm. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

You should not take lisinopril if you’re pregnant or planning to become pregnant. If you take lisinopril during pregnancy, it can harm the developing fetus.

To learn more, see “Pregnancy and breastfeeding while taking lisinopril” below.

Other warnings

Lisinopril may not be right for you if you have certain medical conditions. These are known as drug-condition interactions. Other factors may also affect whether lisinopril is a good treatment option for you.

Talk with your doctor about your health history before starting lisinopril. Factors to consider include those described below.

Risk of angioedema. In rare cases, lisinopril may cause an allergic reaction called angioedema, which is sudden, severe swelling under the skin. Your race may affect how your body responds to this medication. Specifically, you might have a higher risk of this reaction if you are Black. You may also have a higher risk if you have had angioedema in the past. Your doctor will likely not prescribe lisinopril if you have certain kinds of angioedema. Ask your doctor what other medications may be better options for you.

Allergic reaction, including angioedema. If you’ve had an allergic reaction, including angioedema, to lisinopril or other angiotensin-converting enzyme (ACE) inhibitors, your doctor will likely not prescribe lisinopril. Ask them what other medications are better options for you.

Kidney problems. Lisinopril can sometimes worsen kidney problems. If you have kidney problems, you may also have an increased risk of high potassium levels with lisinopril. And if you have dialysis for kidney failure, you may have an increased risk of low blood pressure with lisinopril.

If you have kidney problems, your doctor may prescribe a dosage of lisinopril that’s lower than usual. And they’ll order blood tests to monitor your kidney function and potassium levels.

Heart problems. If you have certain heart problems, you may have an increased risk of low blood pressure and kidney problems with lisinopril. Talk with your doctor about whether lisinopril is safe for you.

Diabetes. If you have diabetes, you may have an increased risk of high potassium levels with lisinopril. Your doctor may order blood tests to monitor your potassium levels while you’re taking lisinopril.

Alcohol and lisinopril

Drinking alcohol with lisinopril may increase the risk of certain side effects, such as:

• headache
• dizziness
• flushing (temporary warmth, redness, or deepening of skin color)
• blurry vision

Also, if you have high blood pressure, regularly drinking alcohol could make your blood pressure harder to manage with lisinopril.

If you drink alcohol, talk with your doctor about how much is safe for you to consume while taking lisinopril.

Pregnancy and breastfeeding while taking lisinopril

Below you’ll find information on taking lisinopril during pregnancy or while breastfeeding.

Lisinopril and pregnancy

Lisinopril has a boxed warning for the risk of fetal harm. A boxed warning is the most serious warning from the Food and Drug Administration (FDA).

Lisinopril is not safe to take during pregnancy. If taken during pregnancy, it can harm the developing fetus.

You should not take lisinopril if you’re pregnant or planning to become pregnant. If you become pregnant while taking lisinopril, you should stop taking the medication and contact your doctor right away. Talk with your doctor about other options for treating your condition that are safer to use during pregnancy.

Lisinopril and breastfeeding

Your doctor will likely recommend that you don’t breastfeed while taking lisinopril. It’s not known if lisinopril passes into breast milk. But if it does, it could cause serious side effects in a breastfed child.

If you’re breastfeeding or plan to breastfeed, talk with your doctor about other treatment options for your condition.

As with most medications, serious side effects are possible with lisinopril, but these occur rarely. Most people who take lisinopril don’t have side effects. If side effects do occur, they’re usually mild and go away in a few days or weeks.

If you have any questions about side effects that lisinopril can cause, talk with your doctor. You can also ask them about Zestril, which is the brand-name version of lisinopril.

A generic drug and its brand-name version are expected to have the same side effects because they contain the same active ingredient. (An active ingredient is what makes a drug work.)

Here are some examples of questions you might want to ask your doctor:

• Do I have a high risk of side effects with lisinopril?
• Do my other medications increase my risk of side effects with lisinopril?
• While taking lisinopril, how often will I need blood tests to check for side effects?

To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Heart failure: clinic, prevention, treatment

ON THE. Semashko

cardiologist of the highest category of the pulmonology department

Yakovleva Marina Alexandrovna.

What is chronic heart failure (CHF)?

Chronic heart failure (CHF) is the inability of the cardiovascular system to provide the organs and tissues of the body with a sufficient amount of blood. CHF develops in violation of the function of the heart, namely its muscular membrane (myocardium). In this case, the heart muscle (myocardium) is not able to properly expel blood from the heart into the vessels under high pressure. In other words, the heart “like a pump” does not cope with its work and cannot pump blood well. CHF is the final stage of most diseases of the cardiovascular system. After a patient is diagnosed with CHF, the survival rate for more than 5 years is only 50%. Every year the number of patients with CHF is growing, this is the most common reason for hospitalization of people over 65 years of age.

The main causes of chronic heart failure

Myocardial infarction – damage to the heart during a heart attack or the remaining scar after it prevents the heart muscle from fully contracting and reduces the contractility of the myocardium.

Arterial hypertension – a systematic increase in blood pressure does not allow the heart muscle to contract adequately.

Heart defects interfere with proper blood circulation due to congenital disorders or acquired changes in valves and other structures of the heart.

Cardiomyopathy – by expanding or narrowing the volume and thickening the walls of the heart, reduce the contractility of the myocardium.

Other reasons for the development of CHF are conditions that increase the body’s tissue demand for oxygen and, accordingly, require increased heart work

Conditions that require increased heart work include:

Factors contributing to the progression of chronic heart failure (CHF)

Cardiac (associated with heart disease)

Myocardial infarction.

Non-cardiac (diseases not related to the heart).

Clinical manifestations of chronic heart failure

1. Shortness of breath: Respiratory failure is accompanied by a feeling of acute lack of air.

This feeling arises “for no reason”, shortness of breath can be constant and not very pronounced, but with the slightest exertion it intensifies and causes an attack of suffocation (cardiac asthma). Shortness of breath worsens when lying down due to increased blood flow to the heart, which forces the person to sit up. More often, cardiac shortness of breath bothers a person at night, forcing him to get out of bed and sit up all night.

2. Tachycardia is an increase in heart rate (HR) and increased heart rate. Like shortness of breath, it can be constant, intensify with little physical exertion.

3. Cyanosis is a bluish discoloration of the skin and mucous membranes (lips, nose, ears and fingertips) due to poor blood supply. Often you can see patients with chronic heart failure who have “blue” lips.

4. Edema – edema first appears on the legs, then on the lower back, abdomen and can gradually spread to the whole body. The classic variant of edema in CHF is swelling in the legs and abdomen (ascites).

5. N swelling of the neck veins occurs due to increased venous pressure, as a result of a violation of the outflow of blood, swelling of the cervical veins is especially pronounced in the supine position.

6. Enlargement of the liver and spleen – the liver and spleen are enlarged due to stagnation of blood in the systemic circulation. The liver becomes hard and painful. Over time, ascites also forms – fluid appears in the abdominal cavity. Liver cells can be damaged, and “cardiac cirrhosis” of the liver develops.

Classification of chronic heart failure

There are 4 functional classes of CHF (according to NYHA):

1 FC – patients with heart disease in whom habitual physical activity does not cause shortness of breath, weakness and / or increased heart rate.

2 FC – patients with heart disease and moderate limitation of physical activity. Shortness of breath, weakness, increased heart rate occur during normal physical activity.

3 FC – patients with heart disease and severe limitation of physical activity. At rest, there are no complaints, but even with a slight load, shortness of breath, weakness and palpitations occur.

4 FC – patients with heart disease, in whom any, even a small load causes shortness of breath, weakness and heart palpitations. These symptoms can also occur at rest.

According to Vasilenko-Strazhesko’s classification, there are three stages of CHF:

I (initial) stage – latent signs of circulatory insufficiency, manifested only during physical exertion by shortness of breath, palpitations, excessive fatigue; at rest hemodynamic disturbances are absent.

II (expressed) stage – signs of prolonged circulatory failure and hemodynamic disorders (stagnation of small and large circulation) are expressed at rest; severe disability:

Period II B – deep hemodynamic disorders involving the entire cardiovascular system (large and small circle). Objective signs – shortness of breath at rest, pronounced edema, cyanosis, ascites; complete disability.

III (dystrophic, final) stage – persistent insufficiency of blood circulation and metabolism, morphologically irreversible damage to the structure of organs (liver, lungs, kidneys), exhaustion.

There are also variants of chronic heart failure:

Diagnosis of chronic heart failure (CHF):

For the diagnosis of CHF and diagnosis, the following additional studies are carried out:

Laboratory tests:

Biochemical blood test (determination of liver enzymes, cholesterol).

Instrumental examinations:

In difficult cases, coronary angiography (X-ray contrast method for examining the vessels of the heart), catheterization of the heart cavities, and computed tomography can also be performed.

When should a patient with CHF see a doctor?

Patients with decompensated chronic heart failure (progression of existing symptoms or addition of new ones) require hospitalization.

Treatment of chronic heart failure (CHF)

reducing the risk of sudden death from CHF.

Non-drug treatment of CHF:

Drug treatment of CHF:

1. ACE inhibitors (adenosine-converting enzyme inhibitors) are a group of drugs that help reduce the risk of sudden death, slow down the progression of CHF, improve the course of the disease, and improve the patient’s quality of life. These include: captopril, enalapril, lisinopril, ramipril, fosinopril, perindopril, quinapril.

2. β-blockers are a group of drugs that reduce the heart rate, improve blood supply to the heart, and increase cardiac output. These include bisoprolol, metoprolol, carvedilol.

3. Diuretics (diuretics): eliminate fluid retention in the body, regardless of the cause of CHF, reduce swelling, reduce the amount of fluid in the body and thereby reduce the load on the heart. Able to quickly, effectively and safely significantly improve the condition of a patient with CHF. These include: furosemide (lasix), torasemide, hydrochlorothiazide, spironaloctone.

4. Cardiac glycosides are drugs that increase myocardial contractility and slow down heart rate. These include: digoxin.

5. Antiarrhythmic drugs – drugs that prevent the development of arrhythmia and reduce the risk of sudden death. One of them is amiodarone.

6. Anticoagulants, antiaggregants – drugs that prevent blood clotting and thrombosis in the vessels. These include acetylsalicylic acid (aspirin), warfarin, new anticoagulants (rivaroxaban, apixaban, dabigatran). Anticoagulants are prescribed to patients with atrial fibrillation (atrial fibrillation), after thromboembolism – to prevent venous thrombosis and ischemic stroke.

7. Drugs that improve myocardial metabolism (potassium, magnesium, B vitamins, inosine, etc.).

Surgical treatment of chronic heart failure.

The only radical method of surgical treatment of chronic heart failure is heart transplantation.

Prognosis and prevention of CHF

The five-year survival threshold for patients with CHF is 50%. The long-term prognosis is variable, it is influenced by the severity of heart failure, concomitant background, the effectiveness of therapy, lifestyle, etc. Treatment of heart failure in the early stages can completely compensate for the condition of patients; the worst prognosis is observed in stage III heart failure.

Measures to prevent heart failure is to prevent the development of diseases that cause it (IHD, hypertension, heart defects, etc.), as well as factors contributing to its occurrence. In order to avoid the progression of already developed heart failure, it is necessary to comply with the optimal regimen of physical activity, taking prescribed drugs, and constant monitoring by a cardiologist.

Arterial hypertension difficult to control

Patient A. , 69years, referred for a consultation with a cardiologist due to a stable increase in blood pressure despite ongoing antihypertensive therapy. Complaints of headaches, dizziness, weakness, palpitations and rapid pulse, shortness of breath during normal physical exertion, various long-term pain in the chest without any connection with physical exertion, swelling of the legs, constantly elevated blood pressure, pain in the knee joints.

History: more than 15 years of arterial hypertension and bronchial asthma. Many years of obesity. 5 years of type 2 diabetes, does not receive insulin. The last 3 years – arthrosis of the knee joints. Observed by a general practitioner, pulmonologist, endocrinologist and rheumatologist. Planned therapy at the time of examination: losartan 100 mg/day, indapamide retard 1.5 mg/day, amlodipine 10 mg/day, glibenclamide + metformin 2.5/400 2 times a day, tiotropium bromide 18 mcg/day by inhalation, nimesulide 100 mg 2 times a day, aspirin 100 mg / day. BP measured at home at 220-180/110-95 mm. rt. Art.

On examination, the condition is satisfactory. Moderate swelling of the legs, more right. Obesity, BMI 38.2 kg/m². Waist 118 cm. BH 18 in 1 min. Hard breathing in the lungs, dry rales during forced exhalation. Exhale free. Heart sounds are sonorous, rhythmic heart rate 94 in 1 min. Accent 2 tones and pansystolic murmur on the aorta. BP 200/110 mmHg The abdomen is soft. painless, significantly increased in size due to subcutaneous fat. The liver is not enlarged. Slight swelling of the right knee joint.

The diagnosis of resistant hypertension is made if, with adequate lifestyle and lifestyle changes and treatment with 3 antihypertensive drugs at the maximum tolerated doses, including a diuretic, a blood pressure level of 140/90 mm Hg or higher is maintained. Thus, in our patient, we can assume resistant hypertension.

True resistant hypertension is diagnosed with optimal treatment and the absence of secondary causes of hypertension. The causes of pseudo-resistant hypertension are doctor’s mistakes (lack of attention to risk factors, errors in antihypertensive therapy), low adherence to the patient’s treatment (non-compliance with the doctor’s recommendations for lifestyle correction and antihypertensive therapy) and the secondary nature of hypertension.

According to research results, the prevalence of RAH is 5-30% of the total number of cases of hypertension and is more common in patients older than 60 years. The risk of developing heart failure, stroke, myocardial infarction, renal failure is directly related to the degree of increase in blood pressure. Studies show that 5-10% of cases of resistance to hypertension have a secondary cause, i.e. cause is symptomatic hypertension.

To make a diagnosis of resistant hypertension, it is necessary to make sure that the patient is taking the prescribed drugs and to check that the rules for measuring blood pressure are followed. It is important to exclude “white coat hypertension” when elevated blood pressure is recorded at a doctor’s appointment, and is at the target level when measured at home. Keeping a diary of blood pressure and daily monitoring of blood pressure allows you to exclude “white coat hypertension”. In our case, when measured at home and at a doctor’s appointment, AH is constantly recorded.

At the appointment, the patient was explained the need for lifestyle changes. Recommended diet with strict restriction of salt and animal fats, weight loss. Written recommendations on diet and food calorie control are given. Taking into account arthrosis of the knee joints, daily exercises are recommended while lying or sitting in a chair. The wearing of compression stockings is recommended, the technique of putting on compression stockings is explained. Given the very high 10-year risk of cardiovascular death on the SCORE scale > 10%, the patient was asked to undergo additional examinations to rule out secondary causes of hypertension (Table 1). Recommended school attendance for patients with hypertension.

Table 1. Causes of secondary arterial hypertension

(Moser M, Setaro F, 2006).

Lifestyle modifications are a key component of hypertension treatment. Patients with hypertension should be advised to:

1. Smoking cessation

2. Decreased salt intake

3. Weight loss

4. Decreased alcohol consumption

5. Exercise

6. Dietary changes (more fruits/vegetables, less fat).

Failure to follow these recommendations is a common underlying cause of treatment failure for hypertension.

Medical therapy.

First-line drugs for the treatment of hypertension are ACE inhibitors or angiotensin receptor blockers (ARBs), diuretics, and calcium antagonists. If treatment fails, if blood pressure remains at 140/90 mmHg or higher recommended:

1. Increase dose and frequency of medication.
2. Start spironolactone (in the absence of CKD).
3. Prescribe loop diuretics in patients with CKD, CHF, fluid retention.
4. Use a combination of alpha and beta blockers.
5. Prescribe centrally acting drugs.
6. Use a combination of dihydropyridine and pulse-lowering calcium antagonists.
7. Strengthen diuretic therapy: prescribe at the maximum doses for hypertension, use a combination of diuretics.

Recommended maximum daily doses of antihypertensive drugs are shown in Tables 2-6.

Table 2. Maximum daily doses of ACE inhibitors

Table 3. Maximum daily doses of ARBs (sartans).

Table 4. Maximum daily doses of calcium antagonists.

Table 5. Maximum daily doses of diuretics for the treatment of hypertension.

Table 6. Maximum doses of alpha-blockers and centrally acting drugs.

Examination carried out. Clinical blood test without deviations from the norm. Clinical analysis of urine – albuminuria. In a biochemical blood test: creatinine 170 µmol/l. (eGFR 28 ml/min/1. 73m², MDRD) – CKD 4, potassium 5.1 mmol/l, blood glucose 9.1 mmol/l, total cholesterol 7.2 mmol/l, LDL 4.6 mmol/l, triglycerides 2.1 mmol/l. HDL – 1.09mmol/l. (hypercholesterolemia and dyslipidemia). Bilirubin and CPK are normal. AST 51 U/l., brain sodium uretic peptide 495 pg/ml – a significant increase confirms the presence of heart failure in the patient.

ECG sinus rhythm. Blockade of the anterior left branch of the bundle of His. Signs of hypertrophy l.zh., systolic overload l.zh.

ECHO CG: L. L. hypertrophy: IVS 13 mm., LVL 13 mm. by type 1. Seal AK and MK. AR 1, mitral regurgitation 1-2 tbsp. Systolic function l.zh. not changed, EF 55%. Changes in ECHO KG are characteristic of arterial hypertension and degenerative valvular disease.

Ultrasound of the kidneys and adrenal glands without pathology.

Ultrasonography of the renal arteries did not reveal stenosis.

Ultrasound of the veins of the lower extremities – expansion of the superficial and communicating veins. Lymphostasis.

X-ray of the knee joints – pronounced manifestations of arthrosis.

In connection with snoring at night, a polysomnography was performed, which made it possible to exclude sleep apnea syndrome.

Diagnosis of coronary artery disease in this patient on an outpatient basis was not possible due to the impossibility of performing a stress test (obesity, joint pain) and MSCT of the coronary arteries (the use of iodine contrast in CKD may be complicated by the development of acute renal failure, therefore it is contraindicated). To assess the risk of coronary artery disease, the coronary calcium index is limiting – 49U – the risk of coronary artery disease is low.

Diagnosed. Hypertension 3st, AH 3 (refractory AH), Risk 4. Hypercholesterolemia, dyslipidemia. Hypertensive nephropathy, CKD 4 tbsp. (eGFR 28 ml/min/1.73m²). Obesity 2 tbsp. CH 3 fn. class Diabetes mellitus type 2, moderate course, subcompensation. Chronic lympho-venous insufficiency of the lower extremities. Bilateral gonarthrosis.

The treatment has been adjusted. The effect of antihypertensive therapy can be weakened by NSAIDs. In addition, the concomitant use of NSAIDs, including selective COX-2 inhibitors, with ARBs (including losartan) may lead to deterioration of renal function, including the possibility of acute renal failure. In connection with the above, nimesulide was canceled. Recommended intra-articular administration of chondroprotectors, the use of ointments, consultation of a traumatologist to decide whether it is reasonable to replace the knee joint.

Due to the presence of CKD with a pronounced decrease in eGFR, metformin is contraindicated. It is recommended to continue taking glibenclamide. A consultation with an endocrinologist was scheduled to correct hypoglycemic therapy.

First-line drugs for the treatment of hypertension are ACE inhibitors or ARBs, diuretics, and calcium channel blockers. The choice of ACE inhibitor or ARB is up to the physician, however, it must be remembered that in the presence of chronic heart failure, any ACE inhibitor can be used and only 3 recommended ARBs: valsartan, losartan or candesartan. The combined use of ACE inhibitors and ARBs is not permitted due to the risk of kidney failure.

If the target level is not achieved with the above drugs, the use of low dose spironolactone is recommended as a fourth antihypertensive drug, Decrease in eGFR less than 30 ml / min / 1.73 m2, plasma potassium levels > 5.0 mmol / l are contraindications to prescribe the drug. In this situation, increased diuretic therapy is recommended. Due to an increase in plasma potassium levels and a significant decrease in eGFR, spironolactone cannot be used in our situation. In CKD, taking thiazide diuretics or indapamide is ineffective, and in this case it is advisable to replace them with loop diuretics. In view of the foregoing, indapamide was replaced by torasemide at a dose of 5 mg. At a dose of 2.5-5 mg, torasemide has a predominantly hypotensive effect, a significant diuretic effect is manifested at a dose of 10 mg and above. The milder and longer duration of action compared to furosemide makes torasemide preferred over furosemide in patients with hypertension and CKD.

If the ongoing drug therapy is ineffective, additional use of alpha-blockers, imidazoline receptor blockers is possible. However, current guidelines for the treatment of hypertension do not contain data comparing the effectiveness of various antihypertensive regimens in the treatment of resistant hypertension. Thus, the choice of a specific treatment regimen remains with the doctor.

In our case, a patient with bronchial asthma is periodically noted by the appearance of a cough. In this situation, sartans are preferred over ACE inhibitors, which can cause a dry cough. In this regard, it was decided to continue treatment with losartan.

Verapamil 240 mg/day was prescribed due to complaints of palpitations, rapid pulse, taking into account bronchial asthma and inability to use beta-blockers. With resistant hypertension and the presence of diseases that limit the intake of a number of antihypertensive drugs, it is possible to use commonly not used combinations of drugs, for example, a combination of pulse-lowering and dihydropyridine calcium channel blockers. The appointment of verapamil or diltiazem allows you to enhance antihypertensive therapy and stop tachycardia. With good control of blood pressure in patients with bronchial asthma, it is also possible to use ivabradine, a blocker of If-channels of the sinus node, which does not affect bronchial conduction, to control tachycardia.

At very high risk of cardiovascular death on the SCORE scale, statins should be prescribed to maintain LDL levels < 1.8 mmol/L. According to the results of tests of hypercholesterolemia and dyslipidemia, the patient was prescribed rosuvastatin at a dose of 10 mg. A slight increase in AST is probably a manifestation of fatty liver, and is not a contraindication for the appointment of statins.

On re-examination 2 weeks later, the patient’s condition improved significantly. Decreased headaches, palpitations, shortness of breath. Leg swelling is gone. BP at home at the level of 170-150/90-100 mm. rt. Art. Pulse 74-82 in 1 min. BP at the reception 160/95 mm. rt. Art. The dose of verapamil was increased to 480 mg (240 mg 2 times in the morning and in the evening). Rilmenidine 1 mg in the morning was added to the treatment,

Rilmenidine is a centrally acting drug – a selective agonist of the medulla oblongata imidazoline receptors, inhibits the sympathomimetic activity of both cortical and peripheral centers, which leads to a decrease in blood pressure. The drug does not affect the function of the heart, does not cause sodium and water retention, does not affect carbohydrate and lipid metabolism, incl. in patients with diabetes mellitus. In patients with CKD and creatinine clearance of more than 15 ml/min, dose adjustment of the drug is not required.

At the control examination after 4 weeks, blood pressure at the level of 150-130/90-80 mm. rt. Art., pulse 70-80 in 1 min according to the diary of self-control. The state of health has significantly improved: there is no heartbeat and pain in the chest, shortness of breath and swelling have decreased, headaches have become less disturbing, the patient has become more active. Blood tests showed a decrease in creatinine to 135 µmol/l, LDL to 2.9 mmol/l, AST and CPK were not elevated, blood glucose was 7.2 mmol/l. It is recommended to continue treatment: losartan 100 mg, torasemide 5 mg in the morning, verapamil retard 240 mg 2 times, amlodipine 10 mg, rilmenidine 1 mg, atorvastatin 40 mg, glibenclamide 5 mg, tiotropium bromide 18 mcg / day inhalation.

Conclusion.

Resistant hypertension is defined as BP ≥140/90 mmHg. rt. Art., which remains uncontrolled, despite treatment with three antihypertensive drugs, one of which is a diuretic in the maximum tolerated doses, subject to the patient’s recommendations for lifestyle modification. The prevalence of RAH is 5-30% of the total number of cases of AH. The risk of developing cardiovascular complications is directly related to the degree of increase in blood pressure. To make a diagnosis of resistant hypertension, it is necessary to make sure that the patient is following lifestyle recommendations, taking prescribed medications, and following the rules for measuring blood pressure.

Lifestyle modification and adherence to treatment remain the most important factors in the treatment of hypertension. There are no data from clinical trials comparing the effectiveness of specific regimens for the treatment of resistant hypertension. First-line drugs for the treatment of hypertension are ACE inhibitors or ARBs, diuretics, and calcium channel blockers. If the combination of the above drugs is not effective enough, additional use of a low dose of spironolactone and / or increased diuretic therapy is recommended. If the ongoing drug therapy is ineffective, additional use of other groups of antihypertensive drugs is indicated.

Literature.

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2. 2018 ESC/ESH Guidelines for the management of arterial hypertension. . Eur Heart J. 2018;34:3021-3104.
3. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Call Card.2018;71(19)). DOI: 10.1016/j.jacc.2017.11.006
4. Calhoun DA, Jones D, Textor S, et al. Resistant hypertension: diagnosis, evaluation, and treatment. A scientific statement from the American Heart Association Professional Education Committee of the Council for High Blood Pressure Research. Hypertension.2008; 51:1403.
5. Moser M, Setaro F. Resistant or difficult-to-control hypertension. N Engl J Med.2006; 355:389-92.
6. Myat A, Qureshi AC, Williams B. Resistant hypertension. clinical review. BMJ.2012; 345 doi: http://dx.doi.org/10.1136/bmj.e7473.
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Please note! This article is not a call for self-medication. It is written and published to increase the reader’s knowledge of their health and understanding of the treatment regimen prescribed by the doctor.