reasons for high BP

[lynnrlpd1]

I've been doing PD for a year yellow bags.  I have gained about 10 pounds during this year but I feel like it is weight gain.  My BP starting rising significantly the last two weeks.  My phosphurus is high and my doctor also recently prescribed hectoral orally for partahyroid.  It seems that is when BP started going up.  Doc told me two days ago to double up on BP meds and when I do my BP is at about 180 but without taking them it is in low 200s which i know is serious.  I am calling him again today.  Can high phosphurus cause high BP.  I have never watched what I ate but just taken binders.  Or any other guesses.  I don't feel like I'm retaining fluid and I'm still urinating.   Whatever I put on I take off and then some but as I said I am urinating except for my long dwell, I usually put in 1600 and only take off about 1400 but I just figured since I am urinating it all evens out.

[Deanne]

I'm having BP problems as well. I was blaming extra fluid, but I'm not so sure that's what it is anymore. Do you have any green bags? You could try them for a couple of days to see if they affect your BP.

Since your phosphorus is high, what if you try being more careful about your diet for a while to see if it makes a difference? I know dietary restrictions are hard - I hate them! It could give you a relatively quick answer though.

[obsidianom]

I dont know your medical status , so dont do anything based on my post without talking to your doctor.
I am concerned about the hectorol as my info on it claims it is contrainicated with hyper-phosphatemia which you indicate you have..
The following is from my drug reference (epocrates) I use.  The folowing are contraindications to hectorol.

hypersens. to drug/class/compon.
hypercalcemia
hyperphosphatemia
vitamin D toxicity
caution if hepatic impairment

So that is one issue . Ask you doctor about that. Also what blood pressure drugs are you on? What doses? 

[lynnrlpd1]

I am taking metoprolol 50 mg twice a day.  Was taking only 1/2 of 50mg until BP started rising

[obsidianom]

I have plenty to say but before I go to it I have more questions. What is your resting pulse now. ?  How long have you been on metoprolol?  Any cardiac Issues? Any other BP meds ever tried? How old are you?

[obsidianom]

For anyone who is interested in BP controland meds, this is general info.
The first line agents are generally diuretics that take off fluid and sodium. Drugs like HCTZ(hydrochlorothiazide) and forosemide are examples. They arent used much in renal patients and rarely if ever in dialysis patients.
The next common class of meds are the calcium channel blockers such as amlodipine . They are quite effective with few side effects.
The other commonly used agents are the ACE inhibitors like Lisinpril or the ARBs like Losartan.  Both classes work at the level of the Renin -angiotensin system. They are rarely done together. Its one or the other usually. There is strong eveidence they are renal protective and often the drugs of choice in renal patients as the renein -angiotensin system comes from the kidneys.
Next come the beta blockers like metoprolol which is a beta 1 blocker . beta 1 mainly effects heart rate and strength of contraction. Beta 1 an2 blockers effect the heart and nervous system . Examples are nadolol and propanolol.  These drugs are older and not used as much now . My cardiologist friend feels there are much better drugs for BP then beta blockers and uses them for cardiac issues mainly.
Next in line are the alpha blockers like doxazosin. They have a lot of side effects but can in some cases be useful.

Most patients with serious BP issues require at least 2 and often 3 different classes combined. It is rare to see a patient on just a beta blocker unless there is some cardiac issue like atrial fib . (I use one for A fib myself).

Hope this helps anyone with general questions on BP control.

[obsidianom]

For anyone who is interested in BP controland meds, this is general info.
The first line agents are generally diuretics that take off fluid and sodium. Drugs like HCTZ(hydrochlorothiazide) and forosemide are examples. They arent used much in renal patients and rarely if ever in dialysis patients.
The next common class of meds are the calcium channel blockers such as amlodipine . They are quite effective with few side effects.
The other commonly used agents are the ACE inhibitors like Lisinpril or the ARBs like Losartan.  Both classes work at the level of the Renin -angiotensin system. They are rarely done together. Its one or the other usually. There is strong eveidence they are renal protective and often the drugs of choice in renal patients as the renein -angiotensin system comes from the kidneys.
Next come the beta blockers like metoprolol which is a beta 1 blocker . beta 1 mainly effects heart rate and strength of contraction. Beta 1 an2 blockers effect the heart and nervous system . Examples are nadolol and propanolol.  These drugs are older and not used as much now . My cardiologist friend feels there are much better drugs for BP then beta blockers and uses them for cardiac issues mainly.
Next in line are the alpha blockers like doxazosin. They have a lot of side effects but can in some cases be useful.

Most patients with serious BP issues require at least 2 and often 3 different classes combined. It is rare to see a patient on just a beta blocker unless there is some cardiac issue like atrial fib . (I use one for A fib myself).

Hope this helps anyone with general questions on BP control.

[Deanne]

Interesting discussion - thanks obsidianom! I'm on metoprolol, too. I was on metoprolol with doxazosin for a long time. Toprol slows my heart rate down a lot and I had a problem with doxazosin making my heart race. Used together, they seemed to work for me. I was able to discontinue both for a while, but like lynnrlpd1, my BP has been creeping back up again and I restarted toprol a couple of days ago when my BP started hitting 160/100. I used to be on 100 mg/day and restarted 25 mg/day. I don't think it's related to phosphorus levels though. I try to be careful about my diet and I've done a pretty good job at keeping my phosphorus level within range.

Why are beta blockers frowned upon? Is it a bad thing that they slow the heart rate?

It's interesting to me that lynnrlpd1 and I are having similar issues and we're using the same BP med. I'm going to order more green bags next time to see if that lets me come back off BP meds. It seemed like using more greens made a bit of a difference in my BP, but I didn't order very well last time.

[lynnrlpd1]

My heart rate has been 87 to 97 the last couple of days.  I am 55 been doing pd for a year, clinic dialysis for a year.  I'm going to try some green bags and  see what happens per the nurse

[obsidianom]

As a general rule alpha blockers can cause reflex cardiac speed up or tachycardia . That is why the beta blocker was added.
The ALLHAT study which loked at antihypertensives over years found alpha blockers had a twofold increased risk of heart failure. With the side effects they have, they are not used as much now. ( my wife is on doxazosin but she is also on 2 other meds for blood pressure so it was an add on).
Beta blockers are used with cardiac arrythmias, ischemic heart disease , and post MI. Otherwise they are nom longer a first line drug of choice. Long term beta blocker use "may' increase the risk of diabetes, . Also they tend to cause fatigue and arent all that great at lowering BP unless they also have alpha blocker component like Coreg(carvedilol) or labetolol.
Most common now are the ACE inhibitors or ARBs. They have multiple protective effects on the heart and kidneys. They can reduce left ventricular hypertrohpy which is common in renal patients. (except in African Americans ). The renin angiotensin system that they effect is very powerful in causing vaso constiction which raises blood pressure. (my wife is on Candesartan which also has anti migraine effects which help her a lot).

As to why anybody is on a certain medication now, I can only say and hope your doctor knows you and picked the medication he/she felt best managed your own unique condition. Medicine is an art more than a science and managing patients is a real art. If something isnt working, question it to your doctor. Go in educated and you will ask better questions and get better results.
I am happy  and comfortable here to discuss medical issues and educate.  I cannot make specific recommendations on your care as I dont know you . But am comfortable guiding anyone in asking their own doctor the right questions to improve care.   That is what I can bring to this board as a spouse and caregiver to a dialysis patient and a still practicing (part time) doctor.

[obsidianom]

quote author=lynnrlpd1 link=topic=30644.msg476363#msg476363 date=1391804987]
My heart rate has been 87 to 97 the last couple of days.  I am 55 been doing pd for a year, clinic dialysis for a year.  I'm going to try some green bags and  see what happens per the nurse
[/quote]Your heart rate is a bit high with 100 mg of metoprolol.  Is that normal for you or has it risen? I would wonder if you have an infection somewhere if your heart rate is up and your BP is up . Do you have a fever or feel ill at all?  Any trouble breathingt? Any chest pain? Any history of clots? Any other meds you are on? Any changes recently in anything?

[lynnrlpd1]

Well looks the green bags worked.  I did one green bag each dayand I did an extra yellow bag exchange yesterday.  The green bags took some fluid off and my BP gradually came down and is good today.  So a point for the pd nurse.  Thanks for holding my hand everybody through another difficult time.