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Had BP Problems, Have Gained Weight. Taking High Medical Dose But BP Not Normal. How To Reduce Weight?
Question: Dear Doctor,
I've had BP problems since 1988. Because I've moved around a bit over the past 20 years, each new doctor wants to change my BP meds. As I've gained from 200 lbs in 1993 to 280 lbs today, my BP meds have increased accordingly to current doses. Even so, it seems my BP tends to be higher than normal - 145/95 on avg. Of course, I know losing weight will fix the underlying problem but I've tried and tried to lose weight but keep gaining (I'm an emotional eater and things are bad right now). Bad news is I'm struggling to lose weight and my insurance company won't pay for baractric surgery.
Questions:
1. After 25 years on BP meds, is it possible my kidneys are damaged from the meds?
2. What should I do? Why do I continue to have BP problems?
3. Are there any special tests I should do?
I've had BP problems since 1988. Because I've moved around a bit over the past 20 years, each new doctor wants to change my BP meds. As I've gained from 200 lbs in 1993 to 280 lbs today, my BP meds have increased accordingly to current doses. Even so, it seems my BP tends to be higher than normal - 145/95 on avg. Of course, I know losing weight will fix the underlying problem but I've tried and tried to lose weight but keep gaining (I'm an emotional eater and things are bad right now). Bad news is I'm struggling to lose weight and my insurance company won't pay for baractric surgery.
Questions:
1. After 25 years on BP meds, is it possible my kidneys are damaged from the meds?
2. What should I do? Why do I continue to have BP problems?
3. Are there any special tests I should do?
Brief Answer:
See detailed Answer
Detailed Answer:
Hi There
Thank you for sending in your query.
You have asked 3 questions and I shall answer them one by one.
1) Most of medications which you have mentioned are quite safe for the kidneys. Their long term use is unlikely to cause kidney damage. The one exception is Losartan-HCTZ. While this is safe per se it can cause kidney problem if you are dehydrated due to diarrhoea, vomiting etc.
What is more likely to cause kidney problem is the high blood pressure itself. So you need to do tests like Blood urea and creatinine levels, a urine analysis and Ultrasound of the kidneys.
These will tell us if you have a kidney problem.
2) I can suggest the following measures for a better BP control:
a. Cut back on the salt as much as possible (Target 4 to 6 gm/day). If possible please see a dietician who can come up with suggestions after reviewing your current diet.
Excess salt negates the beneficial effects of your BP pills.
b. We could definitely change your BP medications to more potent ones. For example losartan is an older medication, short acting and less potent. It could be replaced by olmesartan. However this has to be under the supervision of a physician. We could even add another medication like prazosin.
c. I could also suggest that you repeat a sleep study with the CPAP and see if the settings need to be adjusted.
3. Regarding other tests to be done:
a. Do the tests for the kidneys which I have already mentioned above.
b. I would also recommend a renal artery doppler, ECG and an Echocardiogram. The first test will tell us if you have a reversible cause of high BP. The next two will tell us if the high BP is affecting your heart.
I hope I have answered your concerns.
Fell free to contact me if you have any more questions.
Regards and best wishes
Aditya Bhabhe
See detailed Answer
Detailed Answer:
Hi There
Thank you for sending in your query.
You have asked 3 questions and I shall answer them one by one.
1) Most of medications which you have mentioned are quite safe for the kidneys. Their long term use is unlikely to cause kidney damage. The one exception is Losartan-HCTZ. While this is safe per se it can cause kidney problem if you are dehydrated due to diarrhoea, vomiting etc.
What is more likely to cause kidney problem is the high blood pressure itself. So you need to do tests like Blood urea and creatinine levels, a urine analysis and Ultrasound of the kidneys.
These will tell us if you have a kidney problem.
2) I can suggest the following measures for a better BP control:
a. Cut back on the salt as much as possible (Target 4 to 6 gm/day). If possible please see a dietician who can come up with suggestions after reviewing your current diet.
Excess salt negates the beneficial effects of your BP pills.
b. We could definitely change your BP medications to more potent ones. For example losartan is an older medication, short acting and less potent. It could be replaced by olmesartan. However this has to be under the supervision of a physician. We could even add another medication like prazosin.
c. I could also suggest that you repeat a sleep study with the CPAP and see if the settings need to be adjusted.
3. Regarding other tests to be done:
a. Do the tests for the kidneys which I have already mentioned above.
b. I would also recommend a renal artery doppler, ECG and an Echocardiogram. The first test will tell us if you have a reversible cause of high BP. The next two will tell us if the high BP is affecting your heart.
I hope I have answered your concerns.
Fell free to contact me if you have any more questions.
Regards and best wishes
Aditya Bhabhe
Note: For further queries related to kidney problems and comprehensive renal care, talk to a Nephrologist. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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