Blood Pressure Medication Change

Dear Cleveland Clinic Physicians,

Approximately 10 years ago I had a heart attack and was treated with angioplasty on my LAD. My medication daily dosages for the past ten years have been atenolol(50mg), vasotec(20mg), hydrochlorothiazide(25mg), imdur(30mg), lipitor(20mg), and aspirin(81mg).  Recently(four days ago) my physician changed the Vasotec(20mg) per day to Altace(10mg) per day.  This was done because my systolic blood pressure was starting to rise above 140. All of the other medications remain the same.
Questions:
1.  In general, how long does it take for Altace to lower my systolic blood pressure?  Will I see a change in a week, several weeks, etc.?
2.  Initially the first few days that I have stopped taking vasotec(20mg) and started taking Altace(10mg) I have seen a rise in my blood pressure.  Is this normal?
3.  Does my body have to acclamate to the change in ace inhibitors before I start noticing a drop in my blood pressure?
4.  Does Altace and Vasotec work differently to lower my blood pressure even though they are both ace inhibitors?
The basic reason for the switch from vasotec to Altace was because of the rise in the systolic blood pressure.  Also, my physician indicated that Altace had a longer half-life than Vasotec and it would be more compliant.  That is, I would be able to take one Altace(10mg) per day instead of increasing the vasotec dosage to 20mg twice a day.

Thanks,
Cody

[CCF-M.D.-MJM]

Hello cody,

1. In general, how long does it take for Altace to lower my systolic blood pressure? Will I see a change in a week, several weeks, etc.?

ACEI block like Altace block and enzyme in involved with blood pressure regulation.  Traditionally we say that it takes medications 4-5 half-lives until it reaches its full effect.  This may not be true with ACEI and I would expect that after the first dose or two,  you should see its effect on blood pressure.

2. Initially the first few days that I have stopped taking vasotec(20mg) and started taking Altace(10mg) I have seen a rise in my blood pressure. Is this normal?

Not usually.  Most ACEI work about the same.  There are subtle differences like does it penetrate tissue well and what is the half life.  You usually don't see much difference in blood pressure control.

3. Does my body have to acclamate to the change in ace inhibitors before I start noticing a drop in my blood pressure?

Not usually.  Give a little more time.  It is possible that you are anxious when you are taking your blood  pressure now because you are expecting a change -- this can happen.  You are probably the best person to judge if this is a possibility.

4. Does Altace and Vasotec work differently to lower my blood pressure even though they are both ace inhibitors?

The mechanism is the same.  The big difference is the half life is longer with Altace and Altace is considered more a tissue penetrating ACEI.  The most important thing is the blood pressure control, not the type of ACEI used. If this medication doesn't lower your blood pressure enough, a calcium channel blocker like Norvasc is a good next choice.

Good luck and thanks for posting.  Sorry this is a day late -- I didn't have internet access.