HIgh Blood Pressure

[Lori1851]

Hello Friends,
Well looks like the Dr added another BP pill. Dustin now takes 5!!!!!!!!!!!!!!!!!!!!!!!!!! Well 5 in the am along with all the other meds and the same amount at night. One of the Nephs wanted to adjust his dry weight. Dustin told them NO!! He is for the most part always UNDER his dry weight. Do any of you have this kind of problem with your blood pressure? I asked about sodium infusions the end of dialysis Dustin doesn't get those.
The Neph wrote a script also for a BP machine waiting on a prior authorization. Go figure!!!! Any ideas you all have?

 
Lori/Indiana

[okarol]

How Do Blood Pressure Medicines Differ?  - excerpt:
Each patient is different, and medicines that may help one patient may not be best for others. It is important to work with your physician, because there might be some trial and error involved in selecting the best and most effective medicines. Often times, medicines will need to be stopped due to side effects or because they are not working well enough. However, with continued work and patience, a truly effective combination of medicines can be found for almost every patient. For many patients, this may be just one or two medicines, but other patients may require three or four. Again, the most important issue is to find medicines that work to appropriately control your blood pressure while causing the fewest side effects possible.
For complete article go here http://www.aakp.org/aakp-library/blood-pressure-medications/index.cfm

Here's a PDF file - read the whole article here "Resistant or Difficult-to-Control Hypertension" www.uphs.upenn.edu/renal/important pdf/Resistant HTN.pdf

A different approach: "Acute Device-Based Blood Pressure Reduction" http://www.medscape.com/viewarticle/557733_print

[Lori1851]

Thank  you OKarol! I will do some reading.
Lori/Indiana

[okarol]

I attended a Kidney Symposium yesterday and they devoted several hours to the discussion of hypertension, and also uncontrollable BP. I was thinking of you and Dustin so I tried to learn what I could. The nephrologist stressed (over and over) that the optimum BP is 130/80 for kidney patients. They also said that the AVERAGE number of blood pressure meds taken, per patient, nationally, is 3.6. And that it's not unusual to prescribe a patient 8 or 9 different meds simultaneously to control BP. Something I didn't know is how important the use of a diuretic is. They say that with low creatinine they would use a thorazide diuretic whereas with higher creatinine (Stage 4 or 5 kidney failure) a loop diuretic is used. Also ask about ACE 1 or ARB with a diuretic. I hope you'll check with you doctor and see if any of this makes sense because  I took notes but it was a lot of information to take in. I do remember that they said the biggest problems with conrtolling BP are:
1. compliance
2. salt intake (especially with teens)
3. untreated sleep apnea (Treating apnea can actually make BP go way down!)
4. finding the right combination of meds

[Sluff]

I have moderate to severe sleep apnea maybe that is a factor in my high BP. Also sleep apnea contributes to enlarged heart according to one of my Doctors.

[okarol]

2006 American Heart Association, Inc.

ABSTRACT:

Short Sleep Duration as a Risk Factor for Hypertension
Analyses of the First National Health and Nutrition Examination Survey

James E. Gangwisch; Steven B. Heymsfield; Bernadette Boden-Albala; Ruud M. Buijs; Felix Kreier; Thomas G. Pickering; Andrew G. Rundle; Gary K. Zammit; Dolores Malaspina

From the Department of Epidemiology, Mailman School of Public Health (J.E.G., A.G.R.), and Departments of Neurology and Sociomedical Sciences (B.B-A.), Department of Medicine, Behavioral Cardiovascular Health and Hypertension Program (T.G.P.), Department of Psychiatry and Clinilabs Sleep Disorders Institute (G.K.Z.), and Department of Psychiatry, Division of Clinical Neurobiology (D.M.), College of Physicians and Surgeons, Columbia University, New York, NY; Merck Research Laboratories (S.B.H.), Rahway, NJ; Netherlands Institute for Brain Research (R.M.B., F.K.), Amsterdam, the Netherlands; and University of Vera Cruz (R.M.B.), Xalapa, Mexico.

Correspondence to James E. Gangwisch, Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 West 168th St, Room R720E, New York, NY 10032. E-mail jeg64@columbia.edu

Depriving healthy subjects of sleep has been shown to acutely increase blood pressure and sympathetic nervous system activity. Prolonged short sleep durations could lead to hypertension through extended exposure to raised 24-hour blood pressure and heart rate, elevated sympathetic nervous system activity, and increased salt retention. Such forces could lead to structural adaptations and the entrainment of the cardiovascular system to operate at an elevated pressure equilibrium. Sleep disorders are associated with cardiovascular disease, but we are not aware of any published prospective population studies that have shown a link between short sleep duration and the incidence of hypertension in subjects without apparent sleep disorders. We assessed whether short sleep duration would increase the risk for hypertension incidence by conducting longitudinal analyses of the first National Health and Nutrition Examination Survey (n=4810) using Cox proportional hazards models and controlling for covariates. Hypertension incidence (n=647) was determined by physician diagnosis, hospital record, or cause of death over the 8- to 10-year follow-up period between 1982 and 1992. Sleep durations of ≤5 hours per night were associated with a significantly increased risk of hypertension (hazard ratio, 2.10; 95% CI, 1.58 to 2.79) in subjects between the ages of 32 and 59 years, and controlling for the potential confounding variables only partially attenuated this relationship. The increased risk continued to be significant after controlling for obesity and diabetes, which was consistent with the hypothesis that these variables would act as partial mediators. Short sleep duration could, therefore, be a significant risk factor for hypertension.


Key Words: circadian rhythm • obesity • diabetes mellitus • hypertension, essential • sleep
FULL Article: http://hyper.ahajournals.org/cgi/content/short/47/5/833

[Lori1851]

OKarol,
Thanks for the info.    I will look into the diuretic. Thanks for thinking of Dustin and me
Lori/Indiana

[mysty]

Although I'm not the one on dialysis.. the doc had to take me off the diuretic...
Two reasons.. .. and dont laugh at the first one..hair loss!!.. I dont think I have Kojaks head..
second reason..I already had surgery to blast one very large kidney stone that would not pass and got
very very stuck!..
I have its mate in my other kidney.. they dont want to touch it till it starts bothering me...
in the mean time.. I'm sure the little guy is just getting bigger and bigger like a pearl in an oyster

Sadly.. it's started to move.. and the pain bouts are.. painful and I have a high tolerance..
so the doc figures.. soooon very sooooon.. I'm so not looking forward to it..
but.. considering what others go thru.. i feel like a major whimp.. the pain i can handle..
the anesthesia.. just drives me batty!!!....

[pdpatty]

I have been on hemo since June 2007 and my bp is finally coming down. I still take two 40 mg lisinopril and two genetis for Norvasc 5 mg a day.

Bp was 114/73 at dr's office Thurs and standing bp was 153/83 when I left center yesterday.

Dialysis is beginning to worl for me.

[st789]

Talking about BP.  I think teachers know very well about that.  Here have a lot of teachers in this forum.