Change in Blood Pressure Meds a Disaster

[PecanSandie]

I went to my nephrologist two weeks ago. They took my BP and it was absolutely perfect - 118/62 which is hard to believe because my BP is usually high in the doctor's office. At the time, I was taking 10 mg of Amlodipine (maximum dose) and 100 mg of Metoprolol. I was SOOOOO happy!

So the nephrologist looks at my ankles and he clearly doesn't like what he sees because they are puffy (from the Amlodipine - a known side effect). He decides it's time to change my BP medication so he tells me to keep the metoprolol and add 50 mg of losartan which I do.

I made the change in medication and suddenly my BP shoots up into the 170/90 range! I call to tell him and they said to take an additional 50 mg of losartan which I do. My BP is still up there in the 160s even with the additional dose. I called my primary care doctor who is on vacation but her substitute says to keep taking it and monitor BP because it takes time to take affect. I agree to this.

I am totally flummoxed as to what to do because I just don't feel right. Who has control over my medication - my Primary or my nephrologist? Which doctor is the blood pressure expert? - I'm not sure. Before I did have puffy ankles to the point where my shoes didn't fit but at least my BP was controlled! Now...who knows? Mary

[jodaer]

Did they say why the BP change instead of a diuretic for the swelling?

[PecanSandie in reply to jodaer]

It's called Calcium Channel Blocker edema" and it isn't caused by water buildup. It's caused by an increase of pressure in the capillaries which result in fluid loss from the capillaries which then leaks out into the surrounding areas. So a diuretic won't help.

[jodaer in reply to PecanSandie]

OK, that makes sense.

[Tr33cy in reply to PecanSandie]

I used to have this issue with Amlodipine, which btw is typically a sign that you might have Primary Aldosterone HBP as the ankle swelling when taking Amlodipine is most common in those with PA, and when I did, I’d go for a lymphodema massage. Worked like a charm. This was before I knew I had PA, now I do the DASH diet (low sodium and 4700 mg of potassium daily predominantly through food), which keeps BP in control. I still take Amlodipine but now am down to 2.5 mg (from 10) and never have ankle swelling. Have your nephrologist do a check of your aldosterone and renin ratio. If it’s over 20% , your BP issue could be PA, and controllable without Losartan.

[Bassetmommer NKF Ambassador]

Sad when the doctors conflict. I was on amlodipine 5mg for a while and it was fine. And I was on Irbesartan. My potassium was getting up there so she cut my irbesartan in half to 150. And she put me on hydralazine. AWFUL stuff. And she increased the amlodipine to 10 and my legs blew up. My heart was in my ears all time and my BP was not better. Went to the cardiologist who agreed NO hydralazine and cut my amlodipine back to 5. He said there was not any better therapeutic outcome from 5 to 10, so back to 5. And we left it at that. My BP went down and has been the lowest ever on less medicine. Friday it was 127/58 at the docs and I have white coat syndrome.

[PecanSandie in reply to Bassetmommer]

Yes, potassium...another problem. It's actually called Losartan Potassium. I am wondering if that is going to cause Potassium problems which I have had in the past.

Your 127/58 is really really good. Which makes me wonder if I shouldn't go to a cardiologist. I really hesitate to get someone else into the act and the nephro and PCP should be able to figure it out, but I might need an intervention...lol.

[Bassetmommer NKF Ambassador in reply to PecanSandie]

I would definitely get a cardiologist. You wouldn't take your Chevy to a Ford company to fix....

[PecanSandie in reply to Bassetmommer]

I felt exactly the same way until I thought to myself - imagine have three doctors trying to make changes to your blood pressure medication. Two is bad enough! 😆

[Darlenia in reply to PecanSandie]

Completely agree with Bassetmommer - see a cardiologist. My hubby had terrible results after following his nephrologist advice to add a blood pressure med (possibly Toprol) which instantly produced edema. The nephrologist then told him to drop the med, but the edema remained. Our primary jumped in to save the day - but hubby wound up on dialysis (which brought his edema and blood pressure under control) within the year or so. My hubby eventually checked in with his cardiologist who shook his head and said newer updated meds were available back then to address his kidney situation - but that most doctors don't really keep up with that field, relying on old information and approaches. So my hubby regrets not having consulted his cardiologist from the very beginning. Please note, too, that everyone is unique. One may take a med and be fine, others may have a reaction. Also, underlying problems matter. My husband, a diabetic, had considerable proteinuria that was being targeted then. Blood pressure meds really need to be tailored to meet one's unique needs.

[drmind in reply to Bassetmommer]

Glad you're off the hydrazaline. That med sent me to the ER most likely due to urine retention. And, the amlopidine blew up my legs. YikesI still have anxiety thinking about thst debacle.

[jodaer]

Curious as to is you monitor your BP at home? I've been doing that and take it to the doctor's office for proof that's its white coat syndrome.

[PecanSandie in reply to jodaer]

I monitor at home. That's why I know something is real wrong. I used to get bent of of shape if my BP was in the 130s. For the past week and a half it's been in the 150-170s. It hasn't been in the120 range since I stopped taking the amlodipine. This is what is particularly scary to me...last night I was doing a NYT crossword puzzle on my laptop and fell asleep on the couch. When I woke up my eyes were totally blurry and I kept thinking my glasses were dirty until I realized, nope, that's my eyes. After about 5 minute the blurriness went away but blurred vision is definitely a symptom of blood pressure that isn't under control.

[Hidden in reply to PecanSandie]

So Amlodipine is bad

[PecanSandie in reply to Hidden]

Nope. It's good for me.

[OldTownhammock in reply to jodaer]

Me too

[jodaer]

Something is definitely going on. I was amlodipine but neph took me off and put me on Spironolactone and Micardis.

[PecanSandie in reply to jodaer]

Maybe it really does take a while for the medications to kick in. I took my BP about an hour ago and it was 135 (not great but much improved) so maybe it's starting to plateau. I sent my nephro an email because I was a little worried about the blurred vision but I am sure he will say to persevere.

[jodaer]

Glad it's going down but keep an eye on it. Wondering if you're diabetic? Blurred vision is a side effect of that. That's how I can tell when my blood sugars are way up. I would see a cardio if possible if it doesn't come down.

[userotc]

This cross-medic experience seems fairly common and your experience has been replicated by 2 close family members of mine in the past 4mths.

Sadly it's what you can expect with drugs combined with >1 medic - both want to play with their "chemistry set"!

It's just 1 of several reasons why we try to avoid drugs at all costs and adopt Nutritional Therapy, where appropriate. Including my mum (ckd3).

[PecanSandie in reply to userotc]

I already adopted the DASH - Mediterranean diet years ago. I totally cut out salt except when baking and I don't eat a lot of baked goods. I eat chicken or turkey maybe once and most twice a week. Fish at least once a week. I buy my veggies from a local organic farm. The excitement of my week is making minestrone (lol). I don't eat junk food at all. I am really keeping my fingers crossed because all the veggies I love seem to have high levels of potassium. My potassium so far has been good but with this new drug you never know since it even has potassium in its name! I would be a pescatarian but my husband would rebel. I also get good exercise - at least 5000 steps 5 times a week. Except for the eGFR/creatinine problem my blood work is good (except for Vitamin D levels which often seem to be slightly low - ironic for someone living in FL) and PTH levels.

It's not a lifestyle issue - I know there is something "off" - but nobody seems to be able to find it. I like the Primary Aldosterone theory because I do think it's something that no one would ever think of that is throwing my BP off. Maybe something to do with parathyroid glands since my PTH is extremely high.

[KidneyCoach NKF Ambassador in reply to PecanSandie]

How high is your pth? Calcium? Phosphorus? Just curious.

[PecanSandie in reply to KidneyCoach]

PTH Intact taken on 10/3 was 120; Calcium 9.8 and Phosphorus 3.2

[KidneyCoach NKF Ambassador in reply to PecanSandie]

IMHO those levels are WWINL. I understand you're in lower CKD levels but even at that, it's still relatively normal. By the time I finally had mine removed the levels were between 3500 to 4000. Best wishes.

[PecanSandie in reply to KidneyCoach]

Thanks KC!

[horsie63]

I take Amlodipine 5 mg and Carvedilol 12.5 mg. Only time I have ankle swelling is when I sit at my desk all day working. My latest "game" is watching my BP during dialysis. I don't take my BP meds in the morning of dialysis days and it's funny watching the range of the BP.

[Silkdog]

I have been taking 10 mg of Amlodipine and 25 mg of Metoprolol for several years now and have no issue. My BP has been under control, however it does go up a little bit in the winter though.

[Miss-guineapig]

If my ‘nursing’ memory serves me well Amlodipine is a beta blocker for hypertension. Where losartan is an Ace inhibitor. I am on Losartan 25mg and it will be increased to 50mg soon, the same as you Sandie. What I would like to say is that Ace inhibitors are invaluable for CKD and are proven to reduce deaths from strokes and heart disease in people with CKD. The drug opens blood vessels so increases blood flow etc. I am very happy to be allowed on this drug at stage 3a, hope this info helps. Wishing you well x

[PecanSandie in reply to Miss-guineapig]

Thanks, Miss guineapig, I hope the Amlodipine works well for you. Amlodipine is actually a calcium channel blocker (CCB) and it really worked well for me, If you don't get the "CCC edema" then I think you will find that it's easy to tolerate.

[Miss-guineapig in reply to PecanSandie]

Hi, I’m not on Amlodipine, as my BP has always been totally fine, thank God. I just Losartan for the best effect long term for my kidneys. It can be complicated for sure, take care x

[PecanSandie in reply to Miss-guineapig]

Losartan is good. I used to take it but had to stop because it was the Losartan with Hydrochlorothiazide which is either good or bad for the kidneys. I was convinced it was bad for me because I was on it when my eGFR plunged so my doctor put me on something else.

[PecanSandie]

Update (if anyone is interested): After some really, really high readings (one was 187/95...!!) doctor changed me from Losartan to Valsartan. The readings have improved to being in the 140+/70 range. Still not good but at least I don't have to think about whether I should go to the emergency room.