Blood pressure before dialysis?

[kristina]

I would like to know of people's experiences with their blood pressure before and during end-stage-renal-failure.
For example, did anyone find their blood pressure got worse and they needed more antihypertensive tablets
to lower the blood pressure as time went on? Or did their blood pressure act in a different way?
I was reading that the kidneys are the main factor in controlling our blood pressure, so I was wondering
how the blood pressure goes from about 20% GFR towards the point of which dialysis becomes necessary?
Thanks for your thoughts, Kristina.

[Restorer]

For a year predialysis, I had slightly elevated blood pressure. I was prescribed Toprol and it went down a bit. When I started dialysis, my blood pressure was okay for about a month, then I started absorbing and retaining fluid and my blood pressure started going up. It was fairly high (avg. 145/105) for a while, and then as I had problems on dialysis, I started retaining more fluid and my pressure went up even more. I got put on a high dose of benazepril, replacing the Toprol, but it didn't help much.

When I finally got on the cycler, it took off a ton of fluid, all my swelling went down, and within a couple days my blood pressure had dropped to normal. All was good until my second episode of peritonitis, and then I started having some ultrafiltration problems, and I started retaining a bit again, and my blood pressure started to go up.

At one point, my blood pressure was so high that it screwed up my vision. At the ER, it was measured at 200/180. Thankfully, my vision has mostly returned by this point.

Recently, I switched doctors, and the new neph prescribed me a couple additional BP meds, Adalat and clonidine. Now my blood pressure fluctuates between pretty high (165/110) and normal, depending on the time of day, when I last took any pills, and what my fluid status is.

As far as generalizations pre-dialysis, I think it's different for everyone. I wasn't diagnosed until my GFR was around 8, but I wasn't prescribed BP meds until a year later.

[marti824]

my blood pressure is actually lower now that I'm on dialysis.  i often do not take any medication at all, and it drops to below 100 with each treatment.  i guess every one reacts differently.

[YLGuy]

I had high blood pressure.  I was taking Caduet plus a beta blocker.  I did not know that my kidneys were failing.  In December I lost my insurance and could not afford the medicine.  At the end of March when I went in to the ER it was 237/125!!!  During HD my pressure drops significantly.  I have had it go as low as 85/57.  They have adjusted my meds so today after dialysis it was 115/78. 

[cariad]

Hi Kristina,

From what I can tell, this is a very individual issue. I am still predialysis, and I believe my GFR is about the same as yours.

I was told when my GFR dropped to around 20 that I should not bring my blood pressure down too low. I am not a medical person, but what I was told is that when you are in kidney failure and your blood pressure drops too low, the kidney has to work that much harder to force blood through. (The term the doctors use is 'perfusion', and this goes too low if your blood pressure is too low).  I know that I start to feel very ill if my systolic drops much below 110. By 100, I am too exhausted and dizzy to do much of anything aside from lying down. Oh, and my creatinine spikes in direct relation to a sustained drop in my blood pressure.

I was told to aim for blood pressure around 130/90, which is what I usually maintain without medication. If my blood pressure does go up too high, I have a low dose of beta blocker to take. The more powerful drugs (Diovan, Lisinopril, Norvasc) bring my blood pressure too low at the lowest dose.

I was verbally attacked on a transplant list once for passing this information along. One person basically said I was an idiot and did not know what I was talking about because SHE had to take loads of blood pressure medication to keep her pressure down to an acceptable range.  Needless to say, I no longer participate in that group.

Hope this helps!

[kellyt]

I found out I had kidney disease and hypertension all at the same visit.  I never had any symptoms of the high blood pressure.  Anyway, it took a year or so to get the right combination of medication that finally controlled my pressure.  ACE inhibitors didn't do jack for me.  By 2007 when we started getting serious about testing and such and getting ready for either dialysis or transplant my BP was so well controlled it was awesome.  Now, since transplant in Nov. my post transplant odctor put me on a different BP medication and I've been asking to be switched back ever since.  On my last visit two weeks ago with my regular neph my BP was 166/109.  He finally agreed to switch me back.  whew!  I've been feeling better.  He delayed switching me because Prednisone can also raise your pressure and it's been slightly high since transplant but not as high as my last visit.

[kristina]

Thank you for all your thoughts about blood pressure. From reading the replies it shows this is a very difficult matter to deal with and, yes, it is individual. As someone who has had two cerebral haemorrhages (clipped aneurysms) and later a stroke at 38 years old, both incidents caused by uncontrolled high blood pressure through a flare-up, I can say there is no way that I allow my blood pressure to go above 140/90. I have been hypertensive since my first renal failure in 1971 and I have taken many types of antihypertensive medication and, yes, these tablets produce all sorts of side-effects, and what suits one might not suit another. My blood pressure was finally well controlled after I was prescribed a cocktail of three different antihypertensives. Slowly things got better and I now take Amlodipine. I insist on getting the make Istin because the side-effects for me are less with this medication and I found this make to be kinder to my body than any other make. At the moment my GFR is about 10% and there has been no change with the amount of Amlodipine I take and my blood pressure is just about controlled, although it does fluctuate. It has been mentioned that when the systolic is down to 100 it makes one sleepy and this is the same for me, so I always hope that it keeps somewhere around 130/70.  I have noticed that chamomile tea has a calming effect and helps to lower my blood pressure as well, but I can only take one mug a day (one chamomile tea-bag three minutes in boiling water and then squeezed, with added sugar). As you might expect, since suffering a stroke I measure my own blood pressure at home to keep a check on it. Thank you very much for your thoughts on this very difficult subject. Kind regards from Kristina.

[Restorer]

Well, since I last posted, I've been prescribed another thing to deal with my blood pressure. It's not directly an antihypertensive medication; it's a diuretic, Bumex. Since my high blood pressure has been tied to whether I'm starting to get fluid overloaded, and my neph doesn't want me using 4.25% bags too often (especially since they cause me abdominal pain), I got this with orders to take it instead of using a 4.25% bag. We'll see if it helps me. The amount I pee has dropped drastically in the last half-year.

[Deanne]

I'm pre-ESRD with function somewhere around 25% or a little less than that. I started out with just an ACE inhibitor, then added Norvasc, then later reduced my dose of the ACE inhibitor and added a diuretic both to combat high potassium (the ACE inhibitor raises potassium) and to suck some of the fluid out of me. I go for a while with stable BP, then it inches up again and have to juggle things around for a few months to stabalize everything and then start the whole routine all over again.

[Sunny]

I did not have high blood pressure till my kidneys became scarred 8 years ago, so my high blood pressure is directly related to kidney disease. My nephrologist tries to help keep my blood pressure under control to prolong the life of my kidneys. My BP runs about 130/90 and it is very hard for me to get it any lower. I am on 240 mg of verapamil taken once in the evening and 40 mg of Benicar taken once in the morning. If I take more, I feel terrible so I refuse to even if it will lower my BP. I have tried dozens of different PB meds over eight years and none of the others do well for me due to side effects. If my BP gets too high, I get migraines and nausea so I completely agree with the need to control my blood pressure. I am on the transplant list at Stanford and those doctors say my level of BP is acceptable at 130/90.

[Lucinda]

Just before starting dialysis my blood pressure was absolutely fine for me.  130/80.  As soon as I started dialysis they stopped my blood pressure meds and my blood pressure went through the roof.  I went on to two new BP tablets and I take one in the morning and one at night.  My "normal" blood pressure is now around 145/90 which is still too high but I wont take any more medication.  I also feel the cold really badly - as we all do - and when I am cold my blood pressure goes up to around 220/120.  Really important not to get too cold because it is quite dangerous as your veins constrict and you put a whole lot of pressure on your heart.  Surprises me why centres are so cold when that is the result of feeling the cold.  I think everyone is really different with their blood pressure but I did really well on medication for five years before I even started dialysis.  People have said that if someone dies during dialysis it is usually because they are taking too much fluid off too quickly and putting a strain on the heart.  I was told recently that it is usually because the patient is freezing cold and their blood pressure rises to a ridiculous level and it causes a heart attack.  I hadn't thought about that before but makes sense!

[monrein]

Pre-dialysis I was on 5 different BP meds, most at the max dose.  Once I started D I was able to come off of all of them and now, almost 6 months post transplant I'm still OK with none.

[Ang]

my BP  has  been  all  over  the  park  during  the  journey  thus  far,on  2  seperate  occassions(weeks  at  a time)  my  BP would  finish  on  80/60  and  nobody  could  tell  me  why,at  the  present  it  fluctuates  from130/90 to 100/70  when  dialysis  is  finished.

[tyefly]

      Monrein...... Thats what I want to have happen...   after tx  I want no part of BP meds.....   I have always had low and everyone in my family  has really good BP.....    I think its the kidney deal....  I hate to take so many pills.....

[Jean]

I have been taking 4 or 5 bp meds since a heart attack 2 years ago, which was 3 months before I was diagnosed with stage 4. Now, suddenly, my bp was 99/44 last week. So the Drs both say I was dehydrated, took me off one of the bps and off the lasix, and it is being very calm at 130/56. I really dont understand the whole thing, but, hey. My GFR is now at 19% but I feel fine now, no more dizziness either. One day at a time.

[monrein]

That dizziness could have been the low BP Jean.  Glad that's gone...the dizziness I mean.