Rheumatoid Arthritis Support Group
Rheumatoid arthritis is a chronic, inflammatory, multisystem, autoimmune disorder. It is a disabling and painful condition which can lead to substantial loss of mobility due to pain and joint destruction. The disease is also systemic in that it often also affects many extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and...
I've been reading about the need for patients with RA to take a blood pressure drug.
The research is so varied.
For example:
In one study I found these notations:
i. ACE-I may be particularly suited to patients with active RA, since they have increased sympathetic activity [228, 229], which may put them in a high renin state [230, 231]. Additionally, these agents may also have a beneficial effect on the course of RA disease per se, since they suppress mediators of inflammation, including reactive oxygen species and CRP and they increase the expression of inhibitory B (inhibitor of nuclear factor-B) [232];
iii. Insulin resistance is a common feature in RA patients [237], especially among those on treatment with GCs [238]. In this setting, -blockers and thiazide diuretics should be avoided, due to their dyslipidaemic and diabetogenic effects. ACE-I, ARBs or CCBs would be preferable for lowering BP [239, 240]; and
I'm wondering if there is a GO-TO first option???
My rheumatologist insists I be on a bp medication due to the possibility of cardiac disease and it's prevalence among his RA population. But he doesn't get involved in WHICH is best. I'm currently on bystolic, a beta blocker. But if I take the prescribed dose of 5mg, I sound asthmatic. I just want to go in armed to my primary doc this week with an opinion on which one to switch to. My primary is not super knowledgeable about RA but he is amazing overall. Thank you!
The research is so varied.
For example:
In one study I found these notations:
i. ACE-I may be particularly suited to patients with active RA, since they have increased sympathetic activity [228, 229], which may put them in a high renin state [230, 231]. Additionally, these agents may also have a beneficial effect on the course of RA disease per se, since they suppress mediators of inflammation, including reactive oxygen species and CRP and they increase the expression of inhibitory B (inhibitor of nuclear factor-B) [232];
iii. Insulin resistance is a common feature in RA patients [237], especially among those on treatment with GCs [238]. In this setting, -blockers and thiazide diuretics should be avoided, due to their dyslipidaemic and diabetogenic effects. ACE-I, ARBs or CCBs would be preferable for lowering BP [239, 240]; and
I'm wondering if there is a GO-TO first option???
My rheumatologist insists I be on a bp medication due to the possibility of cardiac disease and it's prevalence among his RA population. But he doesn't get involved in WHICH is best. I'm currently on bystolic, a beta blocker. But if I take the prescribed dose of 5mg, I sound asthmatic. I just want to go in armed to my primary doc this week with an opinion on which one to switch to. My primary is not super knowledgeable about RA but he is amazing overall. Thank you!
BTW, Benicar, 20 mg, no hct or whaterver. Straight up. Not trying to push drugs; just give an opinion. OK?
My doctor skipped the diuretic drug and gave me lisinopril two years ago to stop spikes. I didn't have high bp, but spiked when anxious. That caused me to have a chronic cough (well documented that up to 30% can't tolerate ACE inhibitors due to the coughing). I visited with diovan briefly and "bottomed out" so my dose was decreased...am now on bystolic which offers an anti-anxiety benefit. But it was prescribed by my regular primary care doc at the urging of my rheumatologist. He feels the majority of RA patients need to be on it due to the chronic inflammation.
But the two never talked about it, or wrote about it.
I guess there is no "one size fits all".
(Which oddly enough is my overall beef with prescriptions. I prefer they be tailored in dosage. )
Thank you! I appreciate the input greatly.
It worked! LOOOOWWW BP.
Do you have asthma? Betablockers can cause bronchospasm. It must be used with caution in people with chronic breathing conditions. An ACE inhibitor might cause you to cough as well if you have existing breathing issues.
Kathy
Regarding ACE - Yes, I got the chronic cough when I was on lisinopril. Got moved to diovan but it didn't seem to take the edge off the spikes.
I don't exactly have asthma. I've had allergy attacks that are somehow correlated to my over-active immune system. I have pretty big allergies, to the point I take allegra daily. Once in awhile something weird happens with my immune system. I'll start having stomach cramps and then a huge histamine attack as if I was having a bad hayfever reaction. It's so odd!
I am on bystolic but you are right. I can take up to 3/4 of a 5mg pill with no wheezing. If I start taking a full 5mg, around day 4 or 5, I will get a wheeze and have to back off. I told my doctor about it on Monday, but he was not concerned. I suppose it was preferred to trying something new? My bp with white coat syndrome galore was 130/82. That's not bad at all considering what I used to get without anything. (easily 150s/90s)
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