My cardiologist and his deputed Specialist Cardiac Nurse Natalie, tell me that the aim for my medication is gradually (0ver 1 - 2 weeks) to increase the dose of beta blocker (bisoprolol) and ACE inhibitor (ramipril) from the original dose of 1.25 mg/day to 10 mg/day. This is in line with the American Cardiology Society and Nice in the UK. Such a big increase is dependent on the patiant's response; blood pressure must be measured regularly. I personally wondered how the dosage was decided, now that such recommendations are supposed to be based on hard evidence (usually a double blind controlled trial). Would anyone really go to the trouble of a large double blind trial to compare say the dosage of 5 mg/day with 10 mg/day, comparing symptoms and more important, outcome, ie duration of life? To be meaningful, it would take many months, probably years. If so I would love to read the study. The authors of my favourite book on the subject "Living well with heart failure" state: "there are likely to be ony small differences in efficacy between low and high doses."
In my case it was decided for the time being to fix the dose of bisoprolol at 2.5 mg/day, and to increase the dos of ramipril every few days. This went on till the dose of ramipril was 5 mg/day; daily blood pressure readings were near the ideal of 120/80. Natalie was pleased with my progress. But I was beginning to experience frequent light headedness when I stood up. I tried rising slowly and deliberately but this made little difference. One day at a friend's house I felt severely dizzy, which didn't pass away for several minutes. Scary..... I didn't pass out or fall, but it was close to it. I saw Natalie ASAP. Although sitting blood pressure was normal, when measured standing it fell to something like 70/45. It was agreed to reduce the dose of ramipril to 2.5 mg/day...This has remained the dose for several weeks now, and mercifully the attacks of light headedness have stopped. It is clear to me that blood pressure routinely must be measured standing as well as sitting.
I have tried to be as active as possible with regular exercise, though I am not managing enough. Proper aerobic and resistance exercise is not easy when energy levels are low, as mine were for week after week. The last few weeks have been much better, and I have plenty of energy for gardening, sometimes dodging between showers in this wet, wet June. Gardening may not be aerobic exercise, getting the heart rate up, but at least it is better than sitting down reading. It uses many muscles gently, and involves bending and stretching. Meanwhile I have increased my personal record for sit/stands to 53 in 4.0 minutes. Increasing that will be hard. At any rate the garden is looking preety good.
