This can certainly be confusing to patients!
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1. Counselling Conundrum: a real question from a patient
2. Concise Conclusion: a straight-forward patient-friendly answer
3. Quick Wrap-up
Clearly, there are nuances that may not be captured in this format. The goal here is to provide you with helpful counselling tips which often draw from multiple sources or those which are not commonly accessed by busy healthcare providers serving the community.
Counselling Conundrum: "My Nurse Practitioner just changed my medication from ramipril to olmesartan, because I was having a cough. They said it's the same medication, only without the cough. Why wouldn't they put me on the olmesartan in the first place?"
Concise Conclusion: The family that olmesartan belongs to is newer than the family of ramipril, so for a long time it was recommended to try the "prils" before the "sartans", because there was more research and experience with them. Today, there generally is no compelling reason to go with a "pril" rather than a "sartan". Whoever originally prescribed your ramipril was likely just following the guidelines that were in effect at the time.
Quick Wrap-up: ARBs are now first line with ACEis, and there's generally no reason to prefer one over the other, except for the fact that ARBs don't have that nasty cough as a possible side effect. In our practice, we don't switch ACEis to ARBs automatically if the patient is stable and not coughing, but we initiate with ARBs preferentially. Keep in mind that olmesartan and telmisartan are long-acting, and therefore we prefer these two due to potentially few BP swings, especially compared to something like losartan (it's short-acting and often is dosed BID).
Dive Deeper
We hope you have found this useful. A reply to this email with any feedback or topic suggestion you may have would be greatly appreciated. Your input will be the key to making this newsletter the best it can be.
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