High BP difficulties

[Athena]

I used to take just my ACE inhibitor and 5 mg of Amlodopine to keep my BP in very good control. That went out the window when I got very sick from gyno issues & electrolyte imbalance at the beginning of this year. My dose of Amlo shot up to 10mg & more recently to 15mg. Then I had to switch to Ibersartan (an ARB) which is far weaker in effect on BP control than the previous ACE. Doc has put me on Lercan (Zanidip) 20mg instead of Amlo to better control the peripheral edema I was experiencing from the high doses.

Well, either the Lercan is not working at all OR I'm imploding - My BP is now in the systolic 180s since yesterday. I've just popped a 5mg Amlodopine tablet which the pharmacist said tips we over a safety threshold & told me to see a doctor tomorrow.

Could it just be the ineffectiveness of the medication? I am going through a lot of high stress right now but I've been stressed before and haven't had such high numbers. I feel otherwise okay (I think). Has anyone been through something like this before?

[Deanne]

I think it's more that as our kidneys fail, they have a harder and harder time of maintaining blood pressure. My BP did the same as the disease progressed. My BP meds were changed and the doses adjusted regularly, depending on results and side effects. I think I was on two or three BP meds by the time my kidneys failed.

[Athena]

Deanne, it seems to me to be the new BP med, as this all started soon after starting this med. The only other thing that's changed is that I've been given a low dose of chinese herb, dong quai, which helps to ease menopausal sypmtons. I feel otherwise well - no swelling, appetite unchanged, no fatigue etc,  so it's a bit of a mystery right now. I've taken an extra 2.5mg of the Amlopodine before bed as BP has only reduced to 150/75 from the earlier 5 mg in the evening. I'll see what tomorrow brings.

[kristina]

Hello Athena,
I am sorry for your BP-difficulties and I also "went through" on-and-off-high-BP-episodes, whilst being pre-dialysis...
My doctor recommended to check-up my BP regularly at home and the pattern was as follows:
My BP was in a normal range in the morning and because of that I took my BP-medication at lunch...
... and then, in the afternoon my BP remained in the normal range, but if in the evening it became higher,
I took another BP-medication to keep the BP in as normal a range as possible...
Good luck wishes from Kristina.
P.S. I have a simple "manual" BP-monitor and I bought it from a professional medical equipment shop ...

[Athena]

Hi Kristina,
Many thanks for your post. That seems to be exactly what I'm going through. Overnight and today I had great numbers (My home BP monitor is regularly used), so I took only 5mg of the Amlodopine this morning with my Ibersartan and went off to my day. This evening it was high again at 165/75 but I have under-dosed so it's not too surprising. I've popped 7.5mg of Amlo and will see what it is later this evening before bed.

At this stage I think the Lercan/Zanidip does not seem as effective as Amlodopine so am going back to 10-15mg per day of Amldopidine for the time being. As soon as I go over 10mg, my ankles start swelling however! Better that than being high!

I'll see what happens next.

[Alex C.]

In my case, my BP was very well controlled by ACE inhibitors, then my Neph tried amlodopine, with extremely poor results. So he switched me back to my ACE, but at a lower dose, and added doxazosin for overnights. That kept me well until my kidneys finally failed....

[Athena]

In my case, my BP was very well controlled by ACE inhibitors, then my Neph tried amlodopine, with extremely poor results. So he switched me back to my ACE, but at a lower dose, and added doxazosin for overnights. That kept me well until my kidneys finally failed....

Alex, why did your doc try to get off an ACE? I believe ACEs are contraindicated once a very advanced stage of renal impairment is reached? I sometimes worry about what these drugs are really doing to the kidneys.

[Athena]

Hooray! 134/72 tonight after taking 10mg of Amlodopine today. We've had a very warm early Spring day so I think the heat has helped relax the blood vessels in the body as well. Hoping this new normality will continue.

[Alex C.]

In my case, my BP was very well controlled by ACE inhibitors, then my Neph tried amlodopine, with extremely poor results. So he switched me back to my ACE, but at a lower dose, and added doxazosin for overnights. That kept me well until my kidneys finally failed....

Alex, why did your doc try to get off an ACE? I believe ACEs are contraindicated once a very advanced stage of renal impairment is reached? I sometimes worry about what these drugs are really doing to the kidneys.

ACE inhibitors also increase your potassium levels. In my case, that was what finally pushed me into dialysis.

[Athena]

Another day of satisfactory systoliic BP readings while being back on 10mg of Amlodopine (readings in the 130s). I have now concluded that the new calcium channel blocker they tried to put me on, Zanidip/Lercan, is simply ineffective in my body. I could repeat the experiment again in a few days time but am reluctant to.