Dr Amir Khan has issued an alert about the blood pressure medication Ramipril after a listener's husband was investigated for angina. The GP discussed the issue on his No Appointment Necessary podcast and on ITV's Lorraine show.
Ramipril, sold under the brand name Tritace, treats high blood pressure, heart failure, and kidney damage. It is also prescribed after a heart attack to prevent future issues like strokes and heart or kidney problems. It works by widening arteries so blood can be pumped around the body more easily.
Polypharmacy concerns
Dr Khan warned that some people are ending up in hospital because they are being over-medicated with drugs they have sometimes been on for 30 or more years.
He said: "Eight million people across the UK are taking five or more medications. 2.2 million are taking 10 or more medications, and it's resulting in about a thousand hospital admissions due to side effects of medication."
He explained that anyone on five or more medications is considered to have polypharmacy, adding: "It's not automatically a bad thing because lots of people are on medication that are keeping them alive and well."
Listener's story
Dr Khan shared a message from a listener whose husband had been on Ramipril for a few years. After listening to the podcast, they checked his blood pressure and found it was "sky high". The husband then told his GP he sometimes gets chest pain and sweats, which he had put down to indigestion.
The listener said: "Obviously now they are trying to rule out angina and adding in another BP medication along with Clopidogrel with ECG and chest X-ray booked tomorrow. Thank goodness we listened to your podcast this morning, could be nothing but always best to check."
Dr Khan said the podcast had received 2.5 million downloads and more than 50 million views across social media in its first year. He added: "It's messages like this that really mean the most."
Side effects and alternatives
The NHS lists common side effects of Ramipril, including a dry, persistent cough, dizziness, headaches, diarrhoea, vomiting, and a mild skin rash.
Dr Khan said common blood pressure tablets like ramipril and amlodipine "do have side effects, which either mean people suffer in silence or stop taking them altogether". He explained that Ramipril alters kidney enzymes to reduce blood pressure, and a byproduct is the release of bradykinin, which can irritate the airways and cause a persistent dry cough.
He pointed out that many patients undergo unnecessary chest X-rays or antibiotic courses when the real culprit is their Ramipril prescription. "Lots of people get put on antibiotics and get sent for chest X-rays, and nothing gets found," he said. "It's the ramipril. There are lots of alternatives."
Rare serious side effects include signs of liver problems, blood or bone marrow disorders, acute pancreatitis, kidney problems, stroke, heart problems, lung problems, and angioedema. Anyone experiencing these should call a doctor, call 111, or go to A&E as appropriate.
