Hello: My blood pressure has been uncontrolled for about 8 months. My primary care doctor has me on 100mg of losartan, and 5mg of amlodipine. I am also taking 1000mg of abiraterone, with 5mg of prednisone; also .4mg of tamsulosin. And I had an orchiectomy.
This morning my BP was 156/97. It’s been running usually about 140/90 during the day.
It seems like whatever changes are made in medications doesn’t work, and my BP creeps backup. What would be a good plan for me to go from here? I am seriously considering stopping the abiraterone and prednisone. It just does not seem worth the risk, especially as I had brothers who died at 51, and 63 of heart issues.
My psa has been undetectable for going on 6 years.
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marc_andersun
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Yes you need to get the BP under control, less than 130/80, so your regimen needs to be change. Losartan is good. It may be helped by a low dose diuretic such as Hydrochlorothyazide (HCTZ) or Chlorthalidone so this should be discussed. Amlodipine is rather weak. But most important is to consider/discuss adding either Prazosin or Doxasosin. These have good evidence in suppressing PCa progression. Tamsulosin may or may not share this action. I would switch to Doxazosin twice daily, starting very low dose and titrate to good BP control. (I had the same problem and now am very well controlled on Losartan 100mg, Chlorthalidone 25mg and Doxazosin 2mg twice daily.) Doxazosin has longer half life so more even control than with Prazosin.
You could try dropping the Zytiga + p to see what happens. Discuss with your MO and follow PSAs if you do. Here is one of several published articles on A1 blockers and PCa: (This one does not specifically include doxazosin but several others do.) MB
I would be very suspect of the Zytiga, I took it for 2 years and my blood pressure was vey erratic. Systolic would have 40+ point ranges during the day. Got as high as 200.
I have been off Z for 2 weeks and my BP is now in the 120-140, hoping to reduce my PB meds soon
I’m not a physician so I can’t address the drug situation. The DASH diet is something to think about. Also, foods high in water seem to actually act like a diuretic
Celery and watermelon are two that have a lot of water. Maybe google could direct you to some sites
Other things that sometimes help to lower BP while taking abiraterone:
1. increase prednisone to 10 mg/day
2. replace prednisone with dexamethasone (e.g., o.5 mg/day)
3. replace prednisone with eplerenone (e.g., 50 mg/day)
4. some combination of the above
My systolic is similar to yours but my diastolic is lower. I've tried all the above. Each helped a little to lower my BP and calf edema. Currently taking dexamethasone + eplerenone with my abiraterone. Search this message board to find more specific info on this subject. Good luck.
Perhaps you are not taking enough prednisone to compensate for the loss of cortisol. Talk to your doctor about increasing the dose to see if that caused the problem:
I would want to look at the increased risk of serious CV event with a BPof140/90 versus the mortality risk increase by stopping a PCa drug treatment. Not too many years ago , for folks our age, 140/90 was in the acceptable range. There is nothing magical about these numbers...eg 130/80 vs 135/85? I doubt the extent of of large increase in CV events associted with the 135/85. You would probably find tons of BP research should you choose to do the research? You will find different Docs with different views on this by doing a youtube search....of course careful studies are the best info to use!!
BPs naturally increase with age....our arteries age!!
it might be worth a consult with a nephrologist. They deal with hypertension issues. My wife’s nephrologist is a hypertension specialist and he collaborates with her cardiologist. Just a thought.
Thanks everyone for your good advice. So, this morning my BP at wakeup was 134/84! It is so erratic. The only thing I can think of I did was salt a couple of hard boiled eggs.
I know exactly what you are talking about. I have been on some type of Blood Pressure medication since my 20s.
When I started taking Zytiga my blood pressure went up just like yours. Cardiologist tried many different combinations of meds but really not a lot of relief.
I told my MO that we needed to do something different. He moved me to 750 mg of Zytiga and the 5mg prednisone that I had been taking. At the same time the Cardiologist also added Clonidine. This did give me some relief but nights were still bad. Doubling the dosage of Clonidine and taking twice a day did smooth it out finally. Of course this was along with a number of other meds daily.
I was concerned when the MO took me to 750 mg that I would lose some of the gains I had made on PSA. Post radiation and taking Lupron injection along with the Zytiga took me from a 9.68 PSA to a 0.04. I have blood work in 2 weeks so I will find out. If my PSA has came back up, I will go back on the 1000mg.
I am not sure if the 750 mg ipo 1000mg did a lot for the blood pressure or not, but it combined with a persistent Cardiologist did help.
I had to stop amlodipine because of edema. I take Lisinopril 40mg. I also take magnesium 400mg and Curcumin 2800mg. Normal bp as well as metabolic panel. Google curcumin/magnesium for bp. God Bless.
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