Low blood pressure

[kristina]

Hello,
I have been pretty constant for months and months but over the last week my blood pressure is on the very low side, causing me to feel very tired and lethargic. I am still taking the same anti-hypertensives and my vegetarian diet generally has not changed. Recently I have been going into dialysis approximately in the 120’s over 60’s and when I come off dialysis I might be down to for example 100 over 66 or thereabouts, which for me is "sleepy-time". I would have thought with little kidney function left (barely 300ml per day) my blood pressure would tend to go higher and not lower but there again I am not sure about all the mechanisms of the body which regulates or causes disturbances with the blood pressure. As a result I am in a position of not quite knowing how to, or whether to adjust my antihypertensives and/or how to go about this. I just thought I would bring this topic up in case anyone has gone through this, experienced it and has had such a change?
Many thanks from Kristina.

[iolaire]

Do you feel you are going under your dry weight?  That's the first cause of low blood pressure.

[kristina]

Many thanks for your very speedy reply, iolaire. You might well be right. Over the last week a nurse commented that my dry weight has risen but it hasn't been caused by water and is most probably the result of a slight change in my diet (my liquid-intake has not changed at all). At the same time I have been having more liquid drawn off at dialysis-sessions, thinking the slight weight increase might have been due to water-retension. As your answer implied, this misinterpretation would in effect, as you say, cause my blood pressure to go down. The answer seems to be to adjust my dry weight slightly higher and take off less water or adjust my diet to reduce my weight and continue taking off the amount I used to take off.
Many thanks once again, it does help to get some feed-back because one can then resolve the problem in one's mind which sometimes is very difficult turning the problem over alone.
Thanks again from Kristina.

[iolaire]

You welcome but I still welcome other suggestions.  Life is complicated.

[Charlie B53]

Even a small increase in physical activity, which may be as small as increased distance or frequency of taking a walk, that increase can build more muscle mass which is much denser than water.  This would be seen as a slight weight gain which could very easily be mistaken for water needing to be removed, resulting in lowered blood pressure for a period of time until the body replaces the lost circulating fluid.

The lowered blood pressure is your major clue. Increase your dry weight to a point your BP's are restored to what is normal for you.  Once your new dry weight is established you will most likely find you still have the very same day to day fluid gain as you had before.  Your dialysis sessions will still be taking off nearly the same volume as before, yet still leave you at the newer higher dry weight.

I've only been in-clinic a few months, we made another increase in dry weight again this morning as my pressures also have been getting too low.  I would often have nightly leg cramps on dialysis days.  Raising my dry weight hopefully will fix both problems.  I went out at 106 today.  I should be fine.  Last month they were trying to get me down to 103.  I was miserable, exhausted, and cramping terribly those night.  BP's in the 90's after treatment.  110 going in.  Yes, I was way too dry.

[cassandra]

How are you now Kristina?

Love, Cas

[Simon Dog]

I went from 4 anti hypertensives (Beta blocker, Ace inhibitor, ARB & a calcium channel blocker) to get my BP down from 160/120 to 120/80 pre-dialysis.    Pressures dropped once on PD, and continued to stay low on HD.   I now take a miniscule beta blocker dose to tame the heart rate, but consider myself having a hypertensive episode when systolic exceeds 100.

[kristina]

Many thanks for the kind explanation Charlie B53 and Simon Dog and many thanks for your kind thoughts, Cassandra.
Fortunately my blood pressure did come back to normal after my dry weight was increased a little ...
... And it looks, as if I had too much water taken off and that drained my body and as a result I had a low blood pressure...
... Now everything is back to normal again and I have learned another lesson  ....
And you are quite right, iolaire: life is complicated ...
Many thanks again from Kristina.