Is your blood pressure under control on D?

[rsudock]

Hi everyone,
 My blood pressure is crazy out of control. 150s to 200s for the systolic and 90 to 100s for the dialystolic. I am freaking out about this and wondering does anyone ever have their blood pressure under control while on dialysis? Also did anyone ever have high blood pressure doing in-center D and then switch to home D and their blood pressure straightened out? My brother is so fortunate to have low pressure on D...I'm jealous.

Also what blood pressure meds and doses are folks on who do have it under (or somewhat) under control? My neph, I love him, but I don't think he really has a clue. Just looking for a plethora of info please...

xo,
R

[Bruno]

My blood pressure was dangerously high (like yours) before I went on dialysis but normalised to the extent that I was able to discard almost all of my medicines within a few days of haemo. It still skated around a bit with low blood pressure problems (between 90 and 110) for a while on dialysis until we sorted out what is called your 'dry' or 'ideal' weight, which is supposed to be what you weigh without the excess fluid your body is carrying because of your kidney failure.
It can still skate around if you have to take off a larger than usual amount of fluid too quickly but this is usually downwards.
Fainting from low blood pressure is a problem many confront on dialysis but I have to say that it is not a situation that happens on home dialysis. I can't speak for others but since I've been home I have not had a blood pressure problem. I put this down to the fact that I am able to avoid those circumstances that make a blood pressure problem possible such a infrequent dialysis sessions.

[okarol]

This article is 3 years old but I think the info is pretty current.

How to Control BP in Dialysis Patients
Rajiv Agarwal, MDApril 24, 2007
 
Both the diagnosis and treatment of hypertension in these patients can be a challenge

The characteritistics of hypertension in hemodialysis patients differ from those in the general population. In dialysis patients, accelerated age-related changes in vascular stiffness, combined with factors peculiar to uremia, contribute to a loss of large and small vessel distensibility. There are also changes in circulatory function, including an increase in systolic BP and widening of the pulse pressure. Systolic hypertension with or without diastolic hypertension is common in dialysis patients and associated with increased mortality risk. Isolated diastolic hypertension is rare in these patients, and diastolic BP is inversely related to cardiovascular risk in those with systolic hypertension (Semin Dial. 2003;16:208-213).

Hypertension (defined as mean predialysis systolic BP greater than 150 mm Hg, or diastolic BP greater than 85 mm Hg, or the use of antihypertensive medications) is found in about 86% of clinically stable, adult hemodialysis patients. In contrast to the prevalence in the general population, the prevalence of hypertension in dialysis patients does not increase linearly with age, and is not influenced by sex or ethnicity. Hypertension is adequately controlled only about 30% of the time in these patients (Am J Med. 2003;115:291-297).

BP and prognosis

The association between predialysis BP and mortality risk in chronic hemodialysis patients has been controversial. Some studies have shown that higher BP in these patients offers a survival advantage. This counterintuitive relationship appears, in part, to be related to the methods of data analysis. An inverse relationship between BP and total and cardiovascular mortality is ob-served when data are analyzed with systolic or diastolic BP as separate models. When both systolic and diastolic BP are considered together, systolic BP becomes a primary risk factor in predicting cardiovascular events in dialysis patients while diastolic BP retains the in-verse relationship (Kidney Int. 2005; 67:1-13).

The role of predialysis BP as a risk factor for mortality was examined in a random sample of 4,499 hemodialysis patients (Am J Kidney Dis. 1999;33:507-517). Low predialysis systolic BP (less than 100 mm Hg) was associated with an 86% increased mortality risk, and the relationship was strongest in patients with congestive heart failure. Pre-dialysis systolic hypertension was associated with an increased risk of cerebrovascular death but not total mortality. Postdialysis systolic BP was associated with an increased mortality risk for both low and high BP levels as compared with mid-range levels.

Systolic BP during the maintenance phase, corrected by hemodialysis, appears to play an important role in determining the patients’ prognoses. The relationship between BP and prognosis was studied in 195 patients new to dialysis (Am J Kidney Dis. 1995;25:405-412). In 46 who died within three years after starting dialysis, systolic BP was higher in both the introduction and maintenance phases than in the patients who survived more than three years. There were no significant differences in diastolic BP during either phase between the survivors and nonsurvivors. The cumulative survival rate was similar in patients whose systolic BP was greater than 160 mm Hg during the introduction phase but decreased to below 160 mm Hg during the maintenance phase and in those whose systolic BP was below 160 mm Hg during both phases; the survival rate of both groups was significantly greater than that of patients whose systolic BP was greater than 160 mm Hg during both phases.

Hypertension diagnosis

BP readings obtained in the hemodialysis unit are often used in therapeutic decision-making and to predict prognosis, but these values correlate poorly with ambulatory BP readings. Sources of BP mea-surement error in hemodialysis patients include interdialytic weight gain, the occurrence of sleep apnea and consequent nocturnal hypertension, and the inability to obtain BP readings in both arms in patients with hemodialysis angioaccess in the arm. The problem is compounded by a lack of standardized BP measurements in these patients and the white coat effect. Precise measurement of BP in hemodialysis patients requires interdialytic ambulatory BP monitoring (Semin Dial. 2002;15:299-304). When this is not possible, BP values obtained in the hemodialysis unit can be used to identify the presence or absence of hypertension but cannot reliably predict ambulatory BP values in individual patients.

A two-week averaged predialysis BP greater than 150/85 mm Hg or a postdialysis BP greater than 130/75 mm Hg has at least 80% sensitivity in the diagnosis of hypertension (Kidney Int. 2006;69:900-906). Specificity of at least 80% can be achieved if predialysis BP greater than 160/90 mm Hg or postdialysis BP greater than 140/80 mm Hg is used. Predialysis BP is superior to postdialysis BP as a screening tool for detecting hypertension in dialysis patients.

Treatment

Dietary sodium restriction and individualization of dialysate sodium delivery are useful initial steps. Predialysis plasma sodium content is relatively constant, and higher dialysate sodium concentrations may promote increased interdialytic fluid ingestion, weight gain, and BP. Compared with the use of standard dialysate, the use of low-sodium dialysate formulated in accord with the patient’s average predialysis plasma sodium level is associated with significant decreases in inter-dialytic weight gain, thirst scores, and episodes of hypotension (Kidney Int. 2004;66:1232-1238). In those with uncontrolled BP at baseline, the use of individualized dialysate is associated with significantly lower predialysis BP. Increased frequency of dialysis may improve BP control and other cardiovascular endpoints in hypertensive patients. Compared with standard thrice-weekly sessions, short daily treatment is associated with significant decreases in 24-hour BP and left ventricular mass index. Daily sessions also increase the likelihood of withdrawing antihypertensive therapy in patients with ESRD who were stable on standard dialysis for at least six months (Am J Kidney Dis. 2001;38:371-376). The beneficial effects may be related to decreases in extracellular water content. Supervised therapy with atenolol or lisinopril has proven safe and effective in controlling hypertension in dialysis patients. Those treated with atenolol three times weekly following dialysis achieved significant reductions in mean 44-hour interdialytic ambulatory BP without any increase in intradialytic hypotensive episodes or changes in serum glucose or potassium levels (Kidney Int. 1999;55:1528-1535). Treatment with lisinopril three times weekly following dialysis is associated with a significant and sustained decrease in the mean 44-hour interdialytic ambulatory BP (Am J Kidney Dis. 2001;38:1245-1250).

Nocturnal dialysis is a novel therapy that appears to improve BP control. A group of 28 patients were switched from conventional to nocturnal treatment and followed for a mean of 3.4 years (Kidney Int. 2002;61:2235-2239). They achieved significant reductions in systolic and diastolic BP, pulse pressure, left ventricular mass index, and the number of prescribed antihypertensive medications. Postdialysis extracellular fluid volumes were similar during conventional and nocturnal dialysis.

Dr. Agarwal is associate professor of clinical medicine in the division of nephrology at the Indiana University School of Medicine in Indianapolis.
 
From the April 2007 Issue of Renal And Urology News

http://www.renalandurologynews.com/how-to-control-bp-in-dialysis-patients/article/20541/

[tyefly]

  I never  have blood pressure issues now that I am on Nstage and at home....  I do remember when I was in center.....  plenty of problems.....   high  then low.....  now   the same before and the same after....

[Riki]

My bp jumps around a lot.  It can be incredibly high one day, then incredibly low the next.  It's slowly been creeping up, 140-160 range for sys.  I got the nurses to drop my dry weight by .5 to see if it would help.  It hasn't done anything for my pressures, but I feel like a million bucks coming off the machine.

[Gandalf]

Irrespective of wet/dry weight, I have a real problem with low BP (80/45 and drops during D horribly).  That is not without its complications (fainting, nausea, vomiting etc), and makes me feel really terrible obviously.  Seems, whatevery way, D does have an impact on BP one way or the other. 

[-Lady Noir-]

Mike was on a high dose of Accupril AND a high dose of Diltiazem, and still had a blood pressure on average of 140-150/90
He was on PD for 18 months

[Tracy]

Before I started In center Hemo D in May of 2010, I was on Lisinipril (seems like I was taking 6  pills a day) for high blood pressure.  Then, when I started D, my BP started coming down.  I now do not take any BP meds and my BP is always very low (100/54).  They have a hard time getting the top number up to 100, which is what my center requires before you can leave.

Good Luck!!   

[KICKSTART]

My blood pressure is always in the 'red' on pd it was and its the same on hemo. I take a cocktail of bp meds, they have never been able to control it , if fact now its got to the crazy stage that my body is so used to it , that if by some miracle i have an odd day it drops slightly i cant deal with it , i feel awful.

[Riki]

one of the things talked about at my appointment today was my blood pressure.  He does not like giving drugs unless he absolutely has to, so he wants to try dropping my dry weight a bit more and see how that helps.  I think anything is worth a shot.

[noahvale]

^^

[brandi1leigh]

My bp jumps around a lot.  It can be incredibly high one day, then incredibly low the next.  It's slowly been creeping up, 140-160 range for sys.  I got the nurses to drop my dry weight by .5 to see if it would help.  It hasn't done anything for my pressures, but I feel like a million bucks coming off the machine.

My BP also jumps a lot. High one day, low the next. I'm still on 2 blood pressure meds. Adjusting my dry weight doesn't seem to have any effect. I can leave at x kilos one day and feel great, the next I can leave at x kilos and have low BP. I've even had my blood pressure drop dramatically when I'm over my dry weight. There is no rhyme or reason. The staff just knows that if I say I'm not feeling well, they need to turn off my goal; regardless of what weight I came in at. They're really good about listening to me, so that helps.

[Riki]

My bp jumps around a lot.  It can be incredibly high one day, then incredibly low the next.  It's slowly been creeping up, 140-160 range for sys.  I got the nurses to drop my dry weight by .5 to see if it would help.  It hasn't done anything for my pressures, but I feel like a million bucks coming off the machine.

My BP also jumps a lot. High one day, low the next. I'm still on 2 blood pressure meds. Adjusting my dry weight doesn't seem to have any effect. I can leave at x kilos one day and feel great, the next I can leave at x kilos and have low BP. I've even had my blood pressure drop dramatically when I'm over my dry weight. There is no rhyme or reason. The staff just knows that if I say I'm not feeling well, they need to turn off my goal; regardless of what weight I came in at. They're really good about listening to me, so that helps.

That's one of the things I like about my nurses.  They ask my opinion on everything, and they don't do anything until I've ok'd it.  A few weeks ago, they were having trouble getting the venous needle in.  I did let them try for a bit, but then asked them to take the needle out.  They asked me if I thought they should try again.  That day, I said no, and they set up the machine for single needle.  From what I've observed, they do this with everyone in the unit

[rsudock]

well the past month the blood pressure hasn't been 200 on the top and the last 2 weeks the blood pressure has been pretty decent 140s over 90s, but now that I started working it has shot up again! I just don't know what to do!!! I keep taking more BP meds but it doesn't help. I am on Lisinopril and Metoprolol. I am freaking out that I am going to have a stroke...I know worrying about it doesn't help but I wish I could better control it and live! Now that it is high I feel like I should stay in bed and not stress myself.

Anybody else want to chime in about their blood pressure? Anyone else have high BP continously on in center D...how many years?

xo,
R

[Des]

yep 100%

[monrein]

Before returning to D while my last transplant was going downhill I was on several BP meds, some at the maximum recommended dose.  On D, it stabilized totally so I came off all of them..,I was on short daily (2 and 1/2 hours X 5 days a week).

For me, the biggest key to BP control has always been salt intake and that stuff is hidden everywhere in our North American diet.  Even when I was on all the BP meds, processed foods or any salty stuff would raise my BP and make me retain water in the oddest places.

[KICKSTART]

Mine has been crazy high for years despite 3 lots of bp meds. My salt intake is way below average, i have never used salt even before D. My dry weight is good. But my body is so used to a high bp i feel wrong if it ever drops , which is not very often. I am so intune with my body and my bp i dont even need to have it taken to tell how high it is !

[rsudock]

thanks ladies!

xo,
R

[Restorer]

When I was hospitalized with fluid overload and had to come off PD and go on hemo, I was prescribed a ton of BP meds. Lisinopril, metoprolol, nifedipine, and clonidine. I was taking 3 clonidines a day. The thing with clonidine is if you stop taking it suddenly, there will be a rebound effect and your blood pressure could go dangerously high.

For some reason, that was happening to me even though I was constantly taking clonidine. It no longer had any effect on me, and my blood pressure was staying higher than 180/120, sometimes as high as 220/140. Once I figured that out and got off the clonidine, I was just fine.

Does your blood pressure go down when you eat a substantial meal? I figured out that if I ate a meal before dialysis, my blood pressure stayed around normal for 3 or 4 hours.

[rsudock]

RESTORER glad to see you posting! I was actually just wondering how you were doing. I was reading older posts and realized I haven't seen your avatar around much.

Anyway about the BP it just seems to be constantly high even on D. Like Monday I walked in with BP around 200/100 and then during D it stayed around the 170s over 90s....it seems to be a rare few times that my BP has gotten low. I thought last weekend that maybe my BP had finally righted its self out but by Monday sky high again...I think I am one of those person that needs to be on NXstage...I can't take going 2 days without D.

xo,
R

[billybags]

Husband was on Metoprolol tartrate for 4 weeks after a heart attack. It did not seem to bring his blood pressure down and he did not feel well on this beta blocker. Saw the GP who put him back on to Cardicor Bisoprolo Fumarate that he was on before the attack and his blood pressure is a lot better. Ask to change it and see how you go. If you trawl the sites relating to metroprolol it opens your eyes.

[natnnnat]

RESTORER glad to see you posting! I was actually just wondering how you were doing. I was reading older posts and realized I haven't seen your avatar around much.

I second that.  Such a big lovely grin in that profile pic.
Billybags, i'll have to look for metoprolol now, Gregory takes that.  Remind me to do it tomorrow [yawn]  This is one tired out chicken.  Its 1:52am here, you lot keep a girl up late!

[calypso]

My BP might typically be something like 150/100 just before getting on the machine, then drop down to 146/84 after starting D (probably because some of the blood is outside the body or laying down relaxing or both. Then as the BP meds are dialyzed out on the machine it slowly climbs up to 160/94 or thereabouts. Until I take my BP meds again to get it down.

When I start home nocturnal in about a month hopefully it will come down to normal and be more stable as I'll be doing dialysis 6 days a week so there will be less chance of fluid and sodium to build up.

[billybags]

natnnnat. I Googled     "Metoprolol tartrate v Cardicor Bisoprolo Fumarate apparently there are some law cases going on in America about this one.

[pdpatty]

Standing at dialysis mine runs 190-225 over 110- 125. SEated,it drops like a rock,150/80s then atfer hook up and running about 2 hours ,it can drop to 59/34. (That gets their attention,lol) Think it is all individual.