Can you recommend a kidney-friendly BP med?

[enginist]

I recently was dehydrated from an illness, which caused the kidneys to suffer an acute injury.  When I was discharged from the hospital, I was told to discontinue Lisinopril, my default blood pressure medication, because it is contraindicated in cases involving dehydration.  No one suggested a substitute.  I have combed through the literature on PubMed but can't find anything that is specifically recommended for a recently dehydrated kidney.  Some papers say that Telmisartan has renoprotective properties, but others say that its use should be closely monitored.  Can anyone recommend a kidney-friendly BP med?

[Paul]

Best person to ask is your nephrologist, he/she will not only know the answer, he/she will know what is best for your exact condition. If I posted what I take it would be what is best for me, but not necessarily best for you.

In Britain, once your kidneys are declared 4F all non emergency medication is set by the nephrologist (prescriptions are still written by your GP, but the nephrologist tells him what you need). He even gets notification of all emergency medication and can overrule the decision (although by the time he has been notified you have usually finished the course). He consults with a team of doctors, so he does not have to be an expert in every condition (in my case high blood pressure and diabetes). The idea is that a doctor versed in that condition initially prescribes, the nephrologist decides if it is OK for knackered kidneys and if not they go through the alternative medicines until a suitable one is chosen.

[Simon Dog]

The idea is that a doctor versed in that condition initially prescribes, the nephrologist decides if it is OK for knackered kidneys and if not they go through the alternative medicines until a suitable one is chosen.

This is my procedure here in the US.  The difference is I have to send the emails to get the neph to weigh in.

[Paul]

My nephrologist is based at the hospital where I dialyse, so I don't have to email, I can usually catch him when I go into dialyse.

[kitkatz]

I am so glad to see no recommendations except for see a doctor asap from this thread's participants.  Excellent advice.  We are not a medicine prescriptive site.

[kristina]

I recently was dehydrated from an illness, which caused the kidneys to suffer an acute injury.  When I was discharged from the hospital, I was told to discontinue Lisinopril, my default blood pressure medication, because it is contraindicated in cases involving dehydration.  No one suggested a substitute.  I have combed through the literature on PubMed but can't find anything that is specifically recommended for a recently dehydrated kidney.  Some papers say that Telmisartan has renoprotective properties, but others say that its use should be closely monitored.  Can anyone recommend a kidney-friendly BP med?

Hello enginist,
Everybody in ESRF is different and a BP-medication that may save someone's life, might be poison (... unfortunately I am not exaggerating!) for someone else suffering from a different disease that causes their ESRF, because the reasons for ESRF and BP-issues are different with every patient.
The best way forward seems to ask your GP and/or nephrologist the reason why you are no longer meant to take Lisinopril a.s.a.p and ... you did not mention your current BP-readings ? ...  So perhaps your BP might have normalized again? Please ask your GP and/or nephrologist a.s.a.p.
Good luck wishes from Kristina.

[enginist]

No one said that this is a prescription service, but advice of every kind is freely dispensed on this site, so why not ask for a suggestion.  The problem with BP meds is that there are so many of them, and the literature is so vast, that it's hard to find the safest and most effective.  All of this is compounded by CKD, especially when the CKD is compounded by hypovolemia. 

Besides, I wouldn't be able to take a suggestion, run off to the pharmacy, and buy it over the counter.  It simply isn't possible.  I always consult with my GP and the nephrologist, backing up the consultations with my own research.

As it happens, my nephrologist recommended Amlodipine, which Katrina said that she had used, but my research found that Amlodipine dilates only the afferent arteriorole, which increases the intraglomerular pressure.  In other words, it doesn't have any renoprotective properties beyond its effects on systemic blood pressure.  That doesn't sound ideal to me. 

The best alternative I could find was another calcium channel blocker called Manidipine, which dilates both the afferent and the efferent arterioroles, so it ends up lowering the intraglomerular pressure.  Unfortunately, it isn't available in the United States.  I may try to order it from abroad.

I just read a paper that concluded Amlodipine works as well Manidipine for at least a year. 

Before I suffered dehydration, Lisinopiril was very effective, lowering my BP to 115/70.  When I took it afterwards, it still lowered my BP, but it also dropped my GFR by 10 points.  Now I'm trying very small doses--2.5 mg--of both Lisiniprol and Amlodipine, but so far the combination hasn't lowered the BP, which stands at 145/85.  I don't know what it's doing to the GFR.

There's a lot that I don't understand, but arterioles are small arteries.  The afferent branches off from a main artery and leads to a system of capillaries in the glomerular.  The capillaries transfer waste from the blood to the kidney, and blood flows from the capillaries to the efferent.  Blood pressure is better regulated when the efferent is dilated.

[rcjordan]

I'm on Amlodipine and Coreg (Carvedilol).  The combo works fairly well for me.

[enginist]

Thanks rc.  That's a combination I haven't heard of.  I'll have to look it up. 

[Alexysis]

...but Amlodipine often causes severe edema. I know that when I tried it, I gained 5 lbs water in each leg. Once again, TALK TO A DOCTOR RATHER THAN ASKING FOR ADVICE FROM A BUNCH OF RANDOM PEOPLE ON THE INTERNET. I'm not a doctor, and I doubt anybody else here is, either

[enginist]

I don't think doctors know everything either.  There are almost five million papers on Amlodipine alone.  No one has complete mastery over the field of blood pressure medication. 

[rcjordan]

>combo

My neph started me on this when I first went on dialysis almost 2 yrs ago.  He was hoping to drop the Amlodipine after I was doing well on HHD. That didn't happen as my BP is wack-o, going from very high to very low, sometimes within just a few hours.  Currently, it's mostly stable, but not perfect.  I do not have trouble with edema unless I'm eating in restaurants.

My dosage is 3.125 mg Coreg & 2.5 mg Amlodipine in the morning and 3.125 mg Coreg & 5 mg Amlodipine at bedtime.

Related article:
Taking blood pressure pills at bedtime best for cardiovascular health
https://www.medicalnewstoday.com/articles/326771.php

[enginist]

Why did he want to get you off Amlodipine?  I imagine that HD, as well as its precursor kidney failure, can disrupt anyone's BP.   If yours is fluctuating wildly, your heart is probably at risk.  Hence the Coreg.  3.25 mg is the lowest dose, and the response is said to be dose-related.  However, as the dose increases, so do the side-effects.

[rcjordan]

BTW, I was 130/70 for decades until Stage 3.

>Why did he want to get you off Amlodipine?

He didn't give a specific reason, but the gist of it was that BP usually stabilizes and he can often drop it.  He (and I) are drug minimalists.   I cut back on the Amlodipine for the morning dose because I have trouble with bottoming out during an afternoon HHD session. My neph trusts my judgement, even though he's more adverse to risk than I am.  I keep reminding him that "I'm the best test pilot you've got!" heh

Coreg, even at the low dose, does a good job of keeping my pulse rate down.

[enginist]

Minimalism is usually the safest approach, but it isn't always the most effective.  5 mg of Amlodipine is probably the threshold dose for lowering BP, and maybe you could take it at night to reduce the side-effects.  It does, however, have a long half-life of 35-50 hours.  Ask your doc what he thinks.  Yes, BP can stabilize after a drug is discontinued, but the stability doesn't last much longer than a month or so.  It may be possible to cycle on and off.

I see you take them twice a day.  Altogether, a moderate but effective dose.  I may need to raise the Amlopidine, but 5 disrupts my sleeping habits. 

[justagirl2325]

My husbands meds were different than what i see in this thread.  before his transplant he was on metoprolol.  after the transplant he's now on amlodpine, 5 mg

[enginist]

Hi, 2325.  I don't know anything about the beta blockers.  But I think that Amlodipine is more kidney-friendly than an ACE-i.  A dose of 5 mg seems to be working well right now, with a few but manageable side-effects.

[enginist]

I have found that the effectiveness of Amlodipine depends on the cause and origin--the etiology--of your illness.  If the cause was hypertension, which constricts the afferent arteriole, then Amlodipine, which dilates it, is exactly what is needed.  Its mode of action works as well in cases of nephritis.

[kristina]

I have found that the effectiveness of Amlodipine depends on the cause and origin--the etiology--of your illness.  If the cause was hypertension, which constricts the afferent arteriole, then Amlodipine, which dilates it, is exactly what is needed.  It works as well if nephritis is the cause.

Hello enginist ... and ... I do hope that you are going to have many relaxing years to come with Amlodipine ...
I have been on Amlodipine for some years and hopefully it continues like that (touch wood) ...
Amlodipine is well known to be a very gentle anti-hypertensive medicine, especially for people like myself with so many allergies etc. and I do wish you good luck with it and I also wish to send you seasonal greetings  and best wishes from Kristina.

[enginist]

Hi, Katrina.  I like the Amlopidine so far.  Compared to the Lisinopril, it is a kinder, gentler medication.  Thanks again for the John Field recommendation.  And all the best to you and yours as well.