Hello. Welcome to HCM and thank you for your question. I understand your concern. If EKG is normal, then it means nothing acute is happening with the heart muscle. As for the high blood pressure (hypertension), it is a condition that always tends to progress, and we, the medical crew, always fight to keep it within normal range, i.e. under 140/90 mmHg. The reason why we try to keep the figures lower than those provided, is that constant, long-standing figures above those provided are accompanied with gradual damage of end organs, mostly those who have a dense net of arteries of small calibre, such as the kidney and the eyes. If this is the case, then it is not ramipril that is not working. It rather is that hypertension has gone to another level. This means that another blood pressure-lowering drug should be added to his therapy. Besides ramipril, a beta-blocker, a calcium channel blocker or a diuretic should be added to the therapy at this time, always with the goal of keeping the blood pressure figures within normal range. You should discuss with his cardiologist, about the drug, dosage and frequency which is to be added to the therapy. I hope I was helpful with my answer. Take care. Regards. Dr. Meriton