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New Blood Pressure Recommendations Could Cause Some People Problems

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After five years of deliberation, a committee of experts has revised treatment protocols for hypertension. For one thing, people over the age of 60 will no longer require medication unless their systolic (upper) blood pressure number exceeds 150. For another, beta-blockers like atenolol, metoprolol and propranolol are out as first-line therapies.

The drugs that are now preferred include ACE (angiotensin converting enzyme) inhibitors and ARBs (angiotensin receptor blockers). For many people these drugs are highly effective and do not cause side effects. That's the good news. The bad news is that some people do experience complications from either ACE inhibitors or ARBs. Doctors may not always warn patients about such side effects. Here are some examples of commonly prescribed ACE inhibitors and ARBs and some stories from visitors to our website.

Some Popular ACE Inhibitor Drugs

  • Benazepril (Lotensin)

  • Captopril (Capoten)

  • Enalapril (Vasotec)

  • Lisinopril (Prinivil, Zestril)

  • Quinapril (Accupril)

  • Ramipril (Altace)


ACE INHIBITOR SIDE EFFECTS:

  • Dry cough, uncontrollable cough, nausea, vomiting
  • Dizziness, excessively low blood pressure
  • Kidney function changes, BUN & creatinine elevations
  • Headache
  • Digestive distress, diarrhea, abdominal pain
  • Tiredness, fatigue, malaise
  • Excessive potassium levels (requires immediate medical attention!), irregular heart rhythms, chest pain
  • Elevated uric acid levels
  • Sensitivity to sunlight (photosensitivity), skin rash
  • Angioedema (swelling of face, lips, tongue, throat)
  • Angioedema (swelling in abdomen, severe abdominal pain)
  • Severe allergic reaction (anaphylaxis) requiring emergency treatment
  • Toxicity to liver or pancreas
  • Blood disorders
  • Potential birth defects if taken during early pregnancy
  • Sexual difficulties

 Here are side effect reports from visitors:

"I took lisinopril and complained to my doctor for months about side effects with no results. She pretty much shrugged them off. I was coughing, gagging, waking up at night choking and sometimes vomiting.

"Finally, when I was seeing another doctor about a different matter, he casually commented, when I kept trying to clear my throat, that 'that's caused by the lisinopril, you know.' I almost kissed him! I was so happy to have that problem solved!

"Why don't doctors recognize this side effect?" D.W.


"Lisinopril put me in the ER from violent coughing; I passed out twice from frequent and uncontrollable coughing spells. I was 75 at the time. FINALLY the VA woke up and put me on metoprolol. But the after-effects of lisinopril continue. Before I took it, I could walk miles without problems, climb ladders, crawl under buildings, use a complete range of tools.

"Now I get winded walking 150 feet to the mailbox and back, get short of breath just washing dishes. Lisinopril pretty well ruined my life." R.M.H.

PEOPLE'S PHARMACY RESPONSE: Here is something for you to discuss with your doctors R.M.H. The beta blocker you have been switched to (metoprolol), may be contributing to your shortness of breath. You may no longer be coughing, but some people cannot tolerate beta blockers because they affect the lungs. You should not be getting short of breath just walking 150 feet or washing dishes. Please have your doctor consider the possibility that your "new" medicine is contributing to this problem.


"I had a similar incident with lisinopril and consequently with every ACE inhibitor I have tried. The thing that made me so mad was the fact that I went back to the doctor who prescribed lisinopril and asked her if the ACE inhibitor was causing the cough. She said 'no' and proceeded to prescribe meds for the cough including an antibiotic.

"When I went to the pharmacist with the prescription he said I probably didn't need the antibiotic; that he was sure it was the lisinopril. I didn't fill the antibiotic prescription and called the doctor. She still insisted it was not from the lisinopril and said I should fill the prescription she just gave me."

"I didn't and I also got a new doctor." Mary


We honestly do not understand why so many physicians seem to ignore ACE inhibitor-induced coughs. This is basic pharmacology. Every medical student learns that drugs ending in "pril" such as a captopril, enalapril or lisinopril can cause an uncontrollable cough. And yet many patients are not warned of this side effect, and when they complain are told it is not caused by the drug. Sometimes they spend hundreds or even thousands of dollars seeing allergists, pulmonologists and asthma specialists. They are prescribed cough medicines, antibiotics or asthma drugs, all to no avail. To learn more about this incredible problem, check out our book, Top Screwups Doctors Make and How to Avoid Them.

Although ARBs are less likely to cause an uncontrollable cough, they too can trigger symptoms in susceptible people. Here are some ARBs and side effects to be aware of:

Some Popular ARBs:

  • Losartan (Cozaar)

  • Olmesartan (Benicar)

  • Telmisartan (Micardis)

  • Valsartan (Diovan)


ARB SIDE EFFECTS

  • Dizziness, fatigue, low blood pressure
  • Cough
  • Headache
  • Upper respiratory tract infections, sinusitis, stuffy nose,
  • Digestive discomfort, diarrhea, stomach pain, back pain
  • Joint pain, arthritis
  • Swelling of the face, lips, mouth, tongue or throat (Requires immediate emergency medical treatment )
  • Potassium retention and buildup (hyperkalemia)
  • Kidney damage, liver damage
  • Hair loss

 Some reports from visitors to our website regarding ARB side effects:

"Cozaar and Benicar caused severe cough. My cardiologist told me it couldn't be the Benicar. My internist told me every doctor should know these drugs do cause cough. The pulmonologist did a complete work up and concluded 'it may or may not have been caused by Benicar.'

"It took 18 months for the worst of cough to subside. I still have residual effects 24 months after going off it." E.M.F.


"When I asked my doctor about my horrible dry cough after taking Benicar for a long time, she assured me it must be allergies as my lungs were clear. Also, I had experienced nerve pain in my feet and itching all over.

"I stopped taking Benicar. My BP went up to 135/75 and my cough stopped as well as the pain in my feet and itching." G.G.


"I take Cozaar and HCTZ and have a terrible cough that can awaken me at night. Doctors don't want to explain why I'm having this cough. They told me to see an ENT [ear, nose and throat] doctor.  The ENT says go to your primary doctor.

"This is such a terrible cycle. I feel like I am going in a circle." Carolann


For reasons we don't understand, some doctors seem to be oblivious to the cough-inducing characteristics of ARBs (angiotensin receptor blockers) like Cozaar (losartan). Although far less likely to cause an uncontrollable cough than ACE inhibitors (like lisinopril), drugs like losartan and valsartan can cause this side effect in susceptible individuals. The FDA's official language in the prescribing literature states:

"Cases of cough, including positive re-challenges, have been reported with the use of losartan in post-marketing experience."

THE BOTTOM LINE:

The bottom line on the new blood pressure recommendations is: Do your homework! Never stop a beta-blocker medication suddenly, since that could trigger chest pain, irregular heart rhythms or even a heart attack. Learn about the side effects of ACE inhibitors and ARBs before starting these medications. If you are fortunate and do not experience any complications, great! If, however, you develop any of the symptoms described above, please contact your physician immediately. You may need a different approach to controlling hypertension.

To learn more about the mistakes doctors commonly make when prescribing drugs in general and blood pressure pills in particular, do consider Top Screwups Doctors Make and How to Avoid Them. It just might save a life.

Share your own experience with blood pressure medications below in the comment section.

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32 Comments

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I take Sular twice a day for hypertension. It works and I do not have any side effects. I used to take Atenolol, which caused low heart rate and low energy. After switching to Sular, all was well!

My doctor actually told me that the lisinipril cough was good for me! He gave me some medical mumbo-jumbo explanation of how coughing uncontrollably all day and night was not bad!!!

It might be good to try weight reduction and, a serious attempt at incorporating lifestyle changes into you daily routine, followed by natural therapy to try to treat your hypertension as a first approach.

This is interesting since I am on Lisinopril because I am a type 2 diabetic. My BP has never been as high as 150... usually 120/80 off the med... 105/58 on the med. Who made up this "panel of experts"? Has there been a real study done?

People's Pharmacy response: The people on the panel reviewed a lot of real studies. People with diabetes are at higher risk for heart disease, so your doctor may be treating you although you don't actually have hypertension.

My cough didn't start for a month on the ACE inhibitor, so my doctor concluded it wasn't the fault of the drug. I went through a series of drugs and inhalers and finally insisted we change the BP treatment.

Now I am not only off drugs, I am off doctors and doing great. Years of taking drugs showed me that one drug leads to another.

This new AMA policy with BP is a good thing but it will probably result in younger and younger people being given drugs or being given wrong-headed diet advice like "avoid fats" .

So what am I supposed to do? My upper bp reading can go above 140, sometimes up to 170. I was taken of Lisinopril because of lip swelling, put on Amlodipine that seemed to work well until I had irregular heart beat (a-fib) in March this year and am now on 25mg of Antenolol + Amlodipine.

I have been on ARBS, Tekturna and a thousand and one other BP meds for years. I have lost weight, get moderate exercise for age 75 years.
Doctors don't want to try anything else, they have washed their hands of me and I dislike all the meds.

"ACE INHIBITORS", such as Lisinopril definitely do cause a "persistent, dry cough" in some individuals.

I've heard of many cases where people who simply lost weight, ate a better diet, and exercised regularly, whose symptoms of hypertension, diabetes, and other conditions simply vanished when multi-prescription drugs could not even come close to controlling their symptoms, and they were in fact, in a downward spiral!

There are better ways of getting your high blood pressure under control than necessarily resorting to taking Prescription medication for the rest of your life.

People's Pharmacy response: In our interview with leading cardiologist Sidney Smith, he emphasized the importance of lifestyle changes to lower heart disease risk.
http://www.peoplespharmacy.com/2013/12/21/928-supplements-vitamins-blood-pressure-and-cancer-screening/

A few months ago, your newsletter reported that taking norvasc (or its generic I presume) could lead to breast cancer if
taken over a 10 year period. My drs know nothing about this. How should one proceed with this info? I only take 5 mg
a day, but there was no amount included the info. Appreciate response.

People's Pharmacy response: Here is a link to the article you saw:
http://www.peoplespharmacy.com/2013/09/12/cancer-warnings-on-medications-make-patient-furious/
and here is a link to the original research report your doctors will want to read:
http://archinte.jamanetwork.com/article.aspx?articleid=1723871
It was published in JAMA Internal Medicine on Sept. 23, 2013 and was based on a very large database of patients in Washington state. The authors do warn that more research is needed to confirm this finding.

I take 3 kinds of ARB's and ACE inhibitors and have always suffering from headaches, dizziness, no energy, palpations and stomach problems, but every time I complain was told that it was all in my head. Blood pressure during visits,was within normal of 140/90,but instead of removing medication it was upped on dosage.

Love this new guide lines,for maybe more doctors will pay attention to there patient,when the complains were with in just

I have been on Verelan PM for a number of years with no disease effects. My blood pressure varies from the low 100's to the mid 140's. I am 78. Does this mean I can stop my blood pressure medication?

You might want to ask the authors of this website to investigate the answer to your question.

Lisinopril is derived from "snake venom" (a fact that is probably not widely reported to the American Public as common knowledge). Weight management, lifestyle and dietary changes (such as completely eliminating salt from your diet) will go a long long way towards correcting your hypertension as well as any other medical problems that you may currently be experiencing.

The United States is "highly,over-medicated","highly over stressed", and most of all, "highly over-fed" with the wrong kinds of foods in our diet, (and by the way,"highly over charged" for prescription medication).

People's Pharmacy response: The story on ACE inhibitors (actually captopril, the first ACE inhibitor) being derived from the venom of the Brazilian jararaca snake is quite interesting. Hunt down a copy of People's Pharmacy 3, now out of print, for the story.

Despite the derivation, ACE inhibitors are very useful drugs for those who can tolerate them. Art is correct, though, that following a low-sodium DASH diet (http://www.peoplespharmacy.com/2013/10/03/ward-off-cognitive-decline-with-vegetables-whole-grains-nuts-and-legumes/) can lower blood pressure remarkably well. Adding exercise makes the dietary regimen even more effective for controlling blood pressure and the risk of heart disease.

I was in the ER last Friday almost died due to high blood presser medicine. It also damaged my lungs. I told my doctor I can't take generic medicine. I'm also losing my hair. I want off all medicine. My doctor told me to get another doctor. my bp runs about 125/65.. only goes high if I'm on generic medicine that makes me sick, coughing so bad my lungs don't work. Must go on a pulmo-aide machine. Please can someone help me?

Reading the article today about the ACE's and ARB's is enough to make my blood boil. Almost every day we read about this sort of thing and the Dr's stare at you and virtually lie by omission or straight out lie. We could tick off about half of the side effects listed as being applicable to us!

My husband is 71 and I am 66. My husband is also a Type2 Diabetic. We've both had heart attacks and are on a raft of pills including those mentioned above. My husband was told it's not the pills, you're 71 and that's why you're tired etc. We're both "stuffed" and can't do our normal day to day chores without feeling washed out.

Numerous times we've mentioned these to a Dr and had it shrugged off. We thought the Dr's had a "do no harm" clause in their oath (or perhaps that's been removed since Big Pharma has taken an increased interest in their "bottom line!") We've seriously considered weaning ourselves off these iniquitous drugs but the "fear" factor comes into it and IF we were to have another "event" and they knew we had discontinued our medication, then they'd probably refuse to treat you or put you on worse medication!!

We actually feel quite helpless at the moment. Getting honesty out of the Dr's seems an elusive thing. We've started to see a Chinese therapist but she's away for 6 weeks now so we'll have a big gap in our treatment. We're really hoping for help from her but will have to come to the point where we have to decide about our pills, or her treatment will just have been an expensive exercise. Western and Eastern medicine can't always run parallel. Any constructive comments would be appreciated. We're just about to the end of our tether.

Hello my friend, You need to find yourself a good "Holistic or Natureopathic" Physician.

You'll be pleasantly surprised with the results, I'd say !

Good Luck.

A persistant cough due to taking "ACE Inhibitors" such as Lisinopril is NOT a good thing, and at the very least is a Quality of Life issue!

Prescription Drugs don't have "side effects".

If you're experiencing it, it's a definite "EFFECT"!

I read since Peru everything about Beta Blockers and the side efects. I have high blood pressure, but I want to know what medicine is not bad for our high blood pressure or what can I take for my BP, because all the medicine is not good for us. I am taking enalapril now.
Excuseme my poor English

Americo S.
Trujillo Peru

I have been on Metoprolol for a long time without problems (so I thought), until a few months ago, when I could no longer deny that my hair had thinned A LOT. I mentioned this to my PRP and she suggested I use a topical hair product like rogaine. I did research on the internet and came to the conclusion my hair loss was caused by Metoprolol. I cut my pill in half, and within a very short time, the hair loss stopped. Next visit, I told my PCP and she acted 'surprised'. I believe ALL the doctors know FULL WELL, but deliberately choose to ignore the issue because ALL BP medications have a whole bunch of side effects, leaving the doctors with no good choices and more 'work' than they want, trying to sort out your problem!

Now, even on the 50% reduced Metoprolol of 50 mg, my hair has again started thinning. I tried cutting the dosage even further, but my blood pressure has now gone up to nearly 150/95 and I am at my wits' end.

My solution: Come January 1, I will be on a healthy path to weight loss once again (such as South Beach), as I did a few years ago, when I said 'goodbye' to the BP meds!

Weight loss, regular exercise, reasonable dietary changes with appropriate salt reduction, plus other lifestyle changes are key, and can produce measurable results in a person's overall health, quality of life and longevity.

I too had a bad cough using lisiniprol. I switched to Losartan-HCTZ and am doing fine. Been on it about two years with no side effects. At 68 I do have arthritis but that was developing well before I started the Losartan.

Now I did have bouts of low bp but since taking Natto-Kinase those have tailed off to extremely rare. (Once in three months, down from several times a week.)

Some good information on Norvasc is available on the Web.
Pharmaceutical Companies are not required to list their post-marketing side effect data on their published drug information to Doctors and to the general public, and now that Norvasc has long been off patent, the original manufacturer, Pfizer has little or no motivation in digging into this issue.

You should establish a good rapport with your Healthcare Provider and with your Pharmacist and, choose wisely from services that provide you with good, honest medical advice, along with the time availability required to discuss these very critical issues with you.

Your local Poison Control Centers are staffed 24/7 with Pharmacists who have access to this information on demand, as well drug information and studies that are available from their "Drug Information" departments, as do various other websites online.

The short answer is that you have to take charge of your individual health and have an "advocate in your corner".

Here's some information regarding your question that I found.
Note: "Norvasc" is "Amlodipine".
________________________________________________________________________

Correspondence



Does Amlodipine Increase Cancer Incidence?

Mark R. Goldstein, MD, FACP

To the Editor:

The Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT)1 amplifies the controversy over calcium antagonists and increased cancer risk.2 In this 36-month, placebo-controlled, randomized trial, the calcium antagonist amlodipine had no effect on the angiographic progression of coronary atherosclerosis or on the risk of major cardiovascular events. In the group assigned to amlodipine, the annualized rates of coronary artery bypass grafting and unstable angina were reduced by 1.0% and 2.1%, respectively.

Unfortunately, incident cancers increased in the group assigned to amlodipine. The annualized rate of incident cancers was 1.8% in the amlodipine group and 1.0% in the placebo group. Thus, the 0.8% annualized increase in incident cancer in the amlodipine group was similar in magnitude but opposite in direction to the 1.0% annualized reduction in coronary artery bypass surgery.

Because some observational data suggest that calcium antagonists may cause cancer,2 this finding in PREVENT warrants further investigation. From a public health perspective, for every 1 million patients taking amlodipine for 1 year, the incident cancer rate will increase by 8000 because of the drug. Perhaps we are trading one problem for another.


References
1. Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. PREVENT Investigators. Circulation. 2000; 102: 1503–1510. Abstract/FREE Full Text
2.Pahor M, Furberg CD. Is the use of some calcium antagonists linked to cancer? Evidence from recent observational studies. Drugs Aging. 1998; 13: 99–108. CrossRefMedline

Bertram Pitt, MD
University of Michigan Medical Center

Robert P. Byington, PhD;
Curt D. Furberg, MD, PhD;
Michael E. Miller, PhD;
Ward Riley, PhD
Wake Forest University School of Medicine

Donald B. Hunninghake, MD
University of Minnesota Hospital/Clinic

G.B. John Mancini, MD

+
Author Affiliations
University of British Columbia

Response

We appreciate the comments of Dr Goldstein regarding the incidence of cancer seen with amlodipine in the Prospective Randomized Evaluation of the Vascular Effects of Norvasc Trial (PREVENT).1 Because of the concern raised by Pahor et al,2 we carefully reviewed each case of cancer with an independent group of oncologists. In view of the relatively small number of events, no firm conclusions could be reached regarding the risk of cancer associated with use of amlodipine. Additional cancer data, however, will be available in the next 2 to 3 years from several large-scale trials in which amlodipine is being compared with placebo or other antihypertensive strategies.

We believe that the reduction in the incidence of hospitalization for angina pectoris and the need for revascularization observed in PREVENT suggests a role for amlodipine in patients with coronary artery disease.

Previous Section

References
1.↵ Pitt B, Byington RP, Furberg CD, et al. Effect of amlodipine on the progression of atherosclerosis and the occurrence of clinical events. PREVENT Investigators. Circulation. 2000; 102: 1503–1510.
2.↵ Pahor M, Furberg CD. Is the use of some calcium antagonists linked to cancer? Evidence from recent observational studies. Drugs Aging. 1998; 13: 99–8.

Verelan is "Verapamil" or what's known as a Calcium Channel Blocker.

New guidelines for blood pressure for people over 55 years of age now start treating your blood pressure with prescription medication only if it exceeds 150/90 because of the many side effects that blood pressure medications have that can harm the elderly, including the high probability of injury from falls from taking prescription medication.

It's never a good idea to discontinue any prescription medication on your own without the guidance of your healthcare provider involved in the process because of the danger of rebound,high blood pressure (sort of like twisting a garden hose to slow down the flow of water, and then suddenly untwisting it, resulting in a spike in pressure to your heart and cardiovascular system).

Consult with your healthcare provider before making any potentially dangerous decisions about the very powerful drugs that you get from a Pharmacy.

Sular is another Calcium Channel Blocker for hypertension. low side effects but remember that significant "genetic variation" exists among our population, so what works well for some people dosen't necessary work the in the same way for others.

To Mouse: Please see my post also on 12/27 at 8:59 pm - my suggestion to you is to follow the South Beach "Diet" - I did a couple of years ago, lost a bunch of weight, got much healthier, and no longer needed my BP meds! I never felt or looked so good. January 2nd, I'll be getting healthy once more ... As several people have posted here, I think we are all realizing that the doctors are simply lying to us about our meds - they KNOW problems and side effects, but choose to turn a blind eye.

Western ("Allopathic") Medicine has some advantages but mostly in the surgical end of therapy, as far as health outcomes go.

Eastern ("Holistic" or "Natureopathic") Medicine has many advantages as far as "Natural Therapy" goes, as is the type of medical therapy that this website writes about.

You can have the "best of both worlds" by undergoing, "Integrative Medicine" which combines the best elements of both,but not everyone is predisposed or able to go to "The Mayo" or "Cleveland Clinics".

The sad truth is that your economic level and the area of the Country where you reside will greatly determine your lifespan and your quality of life.

That said, there are still things that you can do to affect your healthcare outcomes positively (and you don't have to live in Rochester, Scotsdale, or San Diego to do it)!

You need to only do as you're doing and getting educated on the appropriate and safe approaches to maximizing the healthcare that you receive,and to find the appropriate medical practitioner to help you along the way.

I might suggest,seeking out a "Holistic" or, "Natureopathic" practioner to do this. There are many MD's who are opening up to "Integrative Medicine", in many parts of the Country now, something that wasn't as commonplace even just a few years ago.

Tekturna is a relatively new drug that came out in the U.S. a few years ago. It was developed in Japan and is what's known as "a Renin Antagonist".

Someone with your condition should definitely be under the care and strict supervision of a Cardiologist, but some additional help from a nutritionist can help you avoid all the "sodium" that processed foods in this country contain.

Just look at video clips of how people in this country looked just 40 or 50 years ago, to see how far wrong we've headed in the opposite direction based on the proper nutrition and, and adequacy of the American diet since then.

Exercise should (and must) be an integral part of your daily routine (30 minutes of walking would be genuinely helpful to you health). Incorporate the proper dietary balance into your daily life, as well as perhaps visiting a "Natureopathic" or "Holistic" practitioner in addition to get some real information from "their side of the fence".

In all fairness to Medical Doctors, many weren't trained in the Holistic or Natureopathic approach to healthcare, but many more are now starting to realize that some real tangible health benefits can be derived from going there, without necessarily having to abandon Western or Allopathic Medicine entirely. (people like "Dr Oz" have come to realize the benefits that can be derived from looking at all sources of healthcare that are available in the world to us).

The United States spends vastly more per capita on Medical Care than anywhere else in the world, but our healthcare outcomes overall are at best only mediocre.

We still have the best healthcare system when it comes to hospitalization and surgical procedures of almost anywhere in the world, though albeit highly expensive.

I am currently on atenolol, felodipine and chlorthalidone. My blood pressure is very well controlled and no way do I want to change the medications I'm on no matter what the current recommendations are!

Where does Lotrel fit into this problem ?

People's Pharmacy response: Lotrel is a combination of a calcium channel blocker (amlodipine) and an ACE inhibitor (benazepril). Both are in the approved category.

Lotrel is a combination product consisting of an ACE Inhibitor (Benazepril)and, a CALCIUM CHANNEL BLOCKER (Amlodipine or "Norvacs").

The same cautions apply to Lotrel as do to any blood pressure medication, including the possibility of persistent cough from the ACE Inhibitor component that some patients experience necessitating in the discontinuation of the product, which is by the way due to the inhibition of a neuro-chemical "Bradykinin" by ACE Inhibitors, to which some patients are predisposed.

Also, there is a possibility physical injury due to falls in the senor population due to dizziness and syncope (lowering of the blood pressure too much) caused by blood pressure medications in general, so caution must also be observed when taking any of these products.

That said, if you're doing well with Lotrel then, there shouldn't be any reason to change medications, since Lotrel is available generically and should be quite affordable to most people.

A good "rule of thumb" in life is, "if it ain't broke, don't fix it", huh?

I am well controlled on my atenolol and it's a high dose I've taken for years without side effects. I certainly don't want to suddenly stop it and run the risk of a heart attack if it's doing the job! Yes, indeed, if it ain't broke don't fix it!!!!!!!

Six months back my friends father used ACE fro blood pressure control but he didn't experienced any kind of side effects! I think these side effects are experience only by some people.

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