So I've been on this forum for approximately 2 years.When I was first diagnosed with stage 2 kidney disease, my blood pressure had exceeded 179 /90; my eGFR 55.
Upon seeing my PCP, I was prescribed Losartan 25 mg daily. I titrated dose 12.5mg twice day; I was overweight by 50 lbs.
Now, 2 years later, lost 45#, stopped Losartan, started & stopped Metoprolol 25mg, started & stopped Atenolol 25mg; restarted Metoprolol @6.25mg daily but couldn't tolerate even this amount. Can't seem to find the right bp med for me, without experiencing the "tanked" bp's, lightheadedness, foggy mentation and even struggles with short-term memory. There's got to be an alternative, I just can't seem to find it.
My labs are okay, sometimes BP's spike & need anti-htn rx. Diet plant based/low % animal protein.
Anyone ever heard of "prn" use bp meds? I know it sounds crazy, but provider's are not extremely educated about meds they prescribe, except maybe pharmacologist. Any words of wisdom or suggestions? I know none of us are md's so I do communicate with my doctors routinely.
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Dana66CKD
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Dana, There are so many meds out there. The fact that you went down to such a low dose is fabulous. I cannot tolerate beta-blockers either. Why did you stop the losartan?
"Losartan is a medicine called angiotensin receptor blocker (ARB). It's widely used to treat high blood pressure (hypertension) and heart failure. It's also used to protect your kidneys if you have both kidney disease and diabetes (diabetic kidney disease)."
Was stable on Losartan 25mg (12.5mg/BID) @ 165-135lbs, but started having episodes of arrythmias, hypovolemia (urgent care visit- treated with IV fluids), dizziness, dehydration, despite drinking 80 oz water/day. I thought was due to too much animal protein intake affecting kidney function, so went completely plant-based diet for several months.PCP changed Losartan to Metoprolol for bp & arrythmias (PSVT's). Did well for several months; HR reg., then irregular HR became more frequent & random dizzy episodes. Both BB & ARB's can cause arrythmias; BB can also cause heart failure. Low % of incidence. Was already taking Losartan when I was initially diagnosed with Paroxysmal Supra Ventricular Tachycardia. So was ARB contributing to? I can't be sure.
No irreg HR now since stopping Metoprolol 6.25mg, but have experienced an array of different symptoms before, during, and after stopping antihypertensives. I will only resume bp med if bp consistently goes above 139/79-80, but don't know for how long & till bp tanks again. Appt. with Nephrology tomorrow.
Anemia can also contribute to changes in HRR, and of course, I am chronically anemic, but not severely. Also have low wbc - lymphocytopenia which also contributes to lightheadedness, foggy mentation... Jeez, what a mess up to now, but I've had great times in between all this!
CT/MRI of brain next on list of things to f/u. PCP is awaiting lab results.
Thank you Bassetmommer for your response. Hope you are doing okay or better🙏
Thanks to a Nutrition & Lifestyle protocol, my mum (ckd3) weaned off a BP drug several years ago. Her BP is generally <130/80 now.
Whilst we research the progress of kidney-related drugs, she is is now drug-free and hopefully will remain so for a long time/forever 🤞. Sorry youve had problems with them.
I'd rather not take bp meds at all since having so much trouble with different side effects. Unfortunately, after stopping meds once before, I had spike in bp after 4-5 days without, despite weaning off. This time has been 4 days so far. No spikes yet 🤞. I check bp daily and haven't felt the symptoms of htn that have occurred before.Thanks for your response. I will discuss tomorrow with provider at appt.
Losartan, then Metoprolol, then Atenolol. Now have prn vasodilator hydralazine 25mg as needed for bp above 160/90-100. BP's low, so no med at this time for now. Keeping record of bp's daily.
Hi Dana. You must be so frustrated. I have also had problems with BP meds causing hypotension. I ended up taking it PRN. I was on 40mg Telmisartan. I live in Australia where it sometimes gets really hot. On particularly hot days I didn’t take it as it would make me really dizzy. My GP (PCP) just saw me as being non-compliant and never looked into changing my medication or dose. So I just continued taking it PRN. When my eGFR started to plummet I even had to figure that out myself that I had CKD3 and insisted that she refer me to a nephrologist. She said okay if you’re feeling anxious!! Needless to say I have since changed my doctor. First thing the nephrologist did was halve my telmisartan dose (BP was 108/71) and told me to take it once a day but at night just before bed. It has sorted out all my problems. She’s keen for me to stay on a small dose as it is an ARB and as bassetmommer said it is protective of kidneys. I now can take it every night without it causing dizziness while exercising on a hot day. I strongly advise you to get your PCP to find a dose of an ARB that you can just take once a day but at night. Perhaps even the Losartan but a lower dose?
I tried Losartan at night. Cautiously & apprehensive, took half tablet (25mg). It worked, no ill effects at that time. Continued rx for several weeks. My home bp monitor senses irregular HR & after couple months, this was happening more often, I felt strange, heart thumping, couldn't sleep. Ended up in UC for hypovolemia & treated with IV fluids. Also wore heart monitor 2 weeks. Many episodes during night of arrythmia, so stopped ARB & started BB. It's been a long road of bad & good days. I am here now feeling better now that the dizziness, which kept me from driving, and the frequent nausea have mostly disappeared. I worried that the ckd was causing my heart to "fail." I have a very patient, supportive daughter that would talk with me on the phone for couple hours to listen to me rant & get me through the extreme anxiety this was causing. I love her so much for just listening! Anyway for now, I feel better. One day at a time & live life loving all my children, grandchildren & two beautiful great-grandchildren I am so blessed to have in my life!
PRN is an abbreviation for the Latin term pro re nata, and that means “as the thing is needed.” This means you may not take a certain medicine at a specific time but rather take it when you need it.
I have a PRN prescription for migraine relief (40 mg, one every 2-3 hrs PRN,), and I have one for SUPER high BPs, called Clonidine. It's for times when my BP spikes over 180 systolic.
I thought would be prescribed clonidine prn too but provider wrote new rx for vasodilator Hydralazine 25mg (1/2 tab). I need to read further about clonidine. The little bit I did read, cautioned that long term, frequent use is not recommended? Don't have all the info read yet.
Well done on the weight loss. I was prescribed the same drugs for high bp as you, also lost weight on plant-based. I cut back on the drugs when bp fell. I kind of like low dose metoprolol for the calming effect. Didn't feel side effects from losartan but my last few blood tests showed low sodium, chloride also low creatinine which made my eGFR appear higher than it probably is, since actual GFR isn't supposed to go up consistently. This blood dilution is a known side effect of losartan, so I stopped a few days ago and don't feel any different, bp still low, my balance is a little better.
Wow, hadn't read about Losartan affecting eGFR, but I've had low sodium & chloride on lab results. Seems reasonable that antihypertensives could lower sodium. They dilate blood vessels, but some work on releasing sodium in the kidneys and with that, causes release of fluid volume which lowers bp too. I was always dehydrated while on Losartan 25mg or 12.5mg. My sodium has been below normal during past 2 years except when I purposely added a small amount of salt to my food. Then it was in low-normal range. EGFR has bounced up & down since diagnosis. With the Sjogren's Syndrome, things have been more erratic lately but at least it explains some of the "whys."Thank you for sharing your experience with me. I've known that ARB's & ACE-I's are the first-line tx for both hypertension & ckd, unfortunately I'm not sure Losartan didn't cause the arrythmia I've had. Metoprolol worked better for me once I started taking and after I was dx'd with PSVT. My arrythmias stopped for a few months, then I noticed they were randomly happening more & more often. Changed to Atenolol because it lasts almost 24hrs; Metoprolol 12hrs.
Now, not taking bp med. BP has remained normal. Lightheadedness & fog better; still having some headache, but not too long each time. I will keep checking my bp daily.
Thanks to all for listening & sharing your knowledge. It is helpful. I never feel alone on this chat forum. And with everyone's input I do talk over with my medical professionals.
Unfortunately, my cardio says, if your not short of breath or dizzy enough to faint, then the arrythmias I have are "my new normal."I can investigate ablation, but he thinks the risk & invasive procedure is not for me at this time? It's a tight spot right now....😔
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