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If this was all well known with doctors and pharmacists then this email would have been superfluous.

From the website of Graedon
Blood Pressure Drug Combos That
Could Be Lethal

Blood pressure drugs can save lives
by preventing heart attacks and
strokes. But combining the wrong BP
drugs can lead to life-threatening
The People’s Pharmacy April 23,
2015 Drug Side Effects Add a
poison pill bottle

When doctors prescribe blood
pressure medication, their goal is
to reduce the likelihood that a
patient with hypertension will
develop heart attacks, strokes,
kidney damage, eye problems or even
Alzheimer’s disease. But some commonly prescribed blood pressure
drugs can interact in dangerous, if
not deadly, ways with other
anti-hypertensive meds or even with

It is not uncommon for health
professionals to prescribe two or
even three different blood pressure
medications to get a patient closer
to “normal.” By the way, there is
growing evidence that aggressively
lowering systolic blood pressure
(below 128) with medications in
older patients may actually
increase the risk for cognitive
decline (more about this here).
ARBs and ACEIs: A Dangerous Blood
Pressure Mix

Our greater concern is the

discovery that certain blood
pressure medications may not play
well together. Two of the most
popular categories of blood
pressure medicines are
angiotensin-converting enzyme (ACE)
inhibitors and angiotensin receptor
blockers (ARBs
). They both belong
to what is called RAS
(Renin-Angiotensin System)

At last count more than 160 million
prescriptions are filled annually
for ACE inhibitor-type drugs. They
include benazepril, captopril,
enalapril, fosinopril, lisinopril,
moexipril, perindopril, quinapril,
ramipril and trandolapril. If there
is a “PRIL” in the name, you can
pretty much assume you are taking

an ACE inhibitor.

ARBs include medications such as
azilsartan, candesartan,
irbesartan, losartan, olmesartan,
telmisartan and valsartan. If there
is a “SARTAN” in the name, you can
pretty much assume you are taking
an ARB. Over 80 million
prescriptions are written annually
for ARBs. While most of the ACE
inhibitors are now available
generically, that is not true for
the ARBs. Brand names like Atacand,
Avapro, Azor, Benicar, Diovan,
Exforge, Micardis and Teveten may
be more likely than their generic

Taken independently, ACE inhibitors
or ARBs are reasonably safe and

quite effective for controlling
high blood pressure. When these
categories are combined, however,
there can be serious complications.

A review of 33 randomized
controlled trials in (BMJ, Jan 28,
2013) comparing treatment with one
single blood pressure medication to
“dual blockade” with both an ARB
and an ACE inhibitor together
revealed some scary results.

The combination therapy led to an
increased risk of a potentially
life-threatening condition called
hyperkalemia (excessive potassium
levels). Too much potassium can
lead to cardiac arrest. Other
adverse reactions associated with
dual therapy included hypotension
(very low blood pressure) and

kidney failure.
How Serious Are These Side Effects?

When your blood pressure drops too
low you can become dizzy and fall.
When an older person falls, it can
lead to broken bones. A hip
fracture is associated not only
with disability but also death.

Kidney failure is another
life-threatening condition
associated with the combination of
ACE inhibitors and ARBs.