In the UK, ramipril is one of the most prescribed drugs, with over 29.3 million prescriptions in 2019 alone.
In this week’s blog, we provide a comprehensive overview of ramipril in the treatment of hypertension. We explain the type of drug ramipril is, how it works in hypertension, guidelines on how to take it, and discuss common side effects and ways to manage them.
Around the world, hypertension (more commonly referred to as high blood pressure) represents one of the biggest risk factors for death. This is because hypertension is the most common risk factor for developing cardiovascular disease (heart failure, myocardial infarction, stroke, coronary heart disease, atrial fibrillation, peripheral artery disease), as well as chronic kidney disease, and even cognitive impairment.
Current estimates suggest that up to 1/3rd of the UK’s population suffers from hypertension.
You may have heard hypertension being referred to as the “silent killer”. This is because hypertension rarely has any noticeable or obvious symptoms, and as such most individuals won’t become aware that they suffer from hypertension.
For this reason, it’s crucial to get your blood pressure checked regularly. You can do this at your GP surgery, in some pharmacies, or even at home, if you have a blood pressure monitor.
If you’re over the age of 40, the NHS strongly recommends that you check your blood pressure at least once every 5 years.
Various approaches can be considered in the treatment of hypertension. Medication is considered very effective as this not only controls hypertension, but it also prevents the occurrence of cardiovascular disease in those patients who are at risk.
Medicines that treat hypertension are called antihypertensives. Several classes have been developed, including angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers and angiotensin II receptor blockers.
In this blog, we’ll focus on ramipril, which belongs to the ACE inhibitors class of antihypertensive drugs.
Also referred to by its brand name Tritace, ramipril is widely used to treat hypertension in the UK and is effective in reducing high blood pressure and preventing the development of cardiovascular disease in most patients.
As we established, ramipril is an angiotensin-converting enzyme (ACE) inhibitor, or just ACE inhibitor for short.
In the body, the angiotensin-converting enzyme (ACE) is responsible for converting the hormone angiotensin I to angiotensin II. After this conversion takes place, angiotensin II acts as a powerful vasoconstrictor (narrows the blood vessels) which raises your blood pressure, among other actions on various systems in the body.
ACE inhibitors such as ramipril work to interfere with this conversion by blocking ACE, so that angiotensin I is not converted to angiotensin II.
This action very effectively reduces blood pressure in patients by dilating blood vessels.
Ramipril is generally taken in one or two dosages per day, and it’s recommended that you take it at the same time every day.
When first starting treatment, ramipril can be very effective at reducing your blood pressure, which can make you dizzy and lightheaded. For this reason, your GP might recommend that you take ramipril before bed. This can also occur when increasing dosages.
You can take ramipril with or without food. Tablets and capsules can be easily swallowed along with a drink, while liquid preparations are expected to come with a measuring tool to help you measure the right dosage to take.
Daily dosage will depend on the reasons for taking ramipril. Most patients will start with a lower dose, which is then gradually increased under GP supervision over the course of a few weeks.
Like any other medication, ramipril is expected to cause side effects in some individuals. The good news is that most people experience little to no side effects. In addition, if you do happen to experience side effects when taking ramipril, in some cases these can improve with time.
Common side effects include:
Although rare, some people do experience serious side effects. Please read the NHS list of serious side effects and call the doctor right away if you experience any symptoms from this list.
The most common symptom that you’re likely to experience from taking ramipril (or other ACE inhibitors) is the dry, irritating, persistent cough.
This is nothing to be concerned about, and it does not mean you are unwell. As ramipril inhibits ACE, this leads to an increased cough reflex.
Cough medicines generally will not help, although sometimes the cough improves without any medication.
If you do experience dizziness and light-headedness, it’s likely that this occurs when standing up abruptly. Getting up more slowly will help, as will sitting down and resting for a while until you feel better.
Headaches can be managed by resting adequately, drinking plenty of fluids, and taking some over-the-counter painkillers.
A big risk associated with diarrhoea and vomiting is dehydration. It’s important to replace any fluids lost by drinking plenty of water. If you’re considering taking medicines to control these symptoms, speak to your GP or pharmacist.
Over-the-counter antihistamines will help manage rashes and itches. Speak to your pharmacist as they will be able to help by recommending a suitable product.
Firstly, avoid driving, using tools or heavy machinery. Speak to your doctor if your blurry vision lasts more than 2 days.
There are a considerable number of medicines that may affect the way ramipril works. For this reason, it is important to always inform your GP of your current medication list including homeopathic, herbal or over-the-counter products.
For a comprehensive list of medicines that may interact with ramipril, please see this official NHS resource.
Ramipril is generally not recommended in pregnancy and breastfeeding, though your doctor might prescribe it in some cases. Your GP will be able to offer more information on the benefits and possible harms of taking ramipril when planning a pregnancy or are already pregnant.
This leaflet is also a good source of information.
If you require more information on ramipril, please visit this official NHS resource.
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