How Can One Regulate The Blood Pressure Levels Without Affecting Their Kidneys While On Several Medication?

Posted on Sat, 23 Sep 2023

Question: My wife has a GFR of 14 so her BP is critical. She is taking 75 milligram of Lopressor in the morning and same at night. She has Afib so she is taking 200 mg of Amiodarone daily for that. She is also taking Amliodipine, 5 mg and 2 1/2 mg in the p.m. She is also on Warfarin, 1 mg, daily. So how can she manage all this and not lower her BP to further hurt her kidneys?

Answered by Dr. Sagar Makode (31 hours later)

Brief Answer:
Needs frequent bp monitoring, monthly INR

Detailed Answer:

Hi,

In her case, it's important to frequently check her bp. Her current medicines are fine with respect to kidney and may continue the same. Our bp target is less than 140/90 (preferably under 130/85) and preferably more than 110 systolic. If bp starts rising then dose of amlodipine may be increased to 5 mg twice a day and similarly may be decreased if bp falls.

So maintaining bp in the range is most important factor to prevent progression of disease. Also, it's important to have diet in similar manner on daily bases, prevent dehydration, which may cause low intermittently. BP may fall during infections so bp should be checked frequently during episodes.

Also, she should get one sugar test done if not done recently which is important coexistent cause for progression.
Next is, she should check her INR once a month and INR should be maintained in 2-3 range. Her intake of green leafy vegetables should be moderate and in same quantities on daily basis as it can affect INR.

So frequently checking bp at home using electronic bp apparatus is important. Also, if one is having dizziness, generalised weakness, increased sleepiness then it points toward low bp and bp should be checked in that scenario.

Hope this helps you and get back if you have any doubts.

Regards

Above answer was peer-reviewed by : Dr. Remy Koshy

Follow up: Dr. Sagar Makode (14 hours later)

The crux of the matter is that her BP is too low and her HR is too high. Lopressor lowers her BP, does it have any affect on her HR? She is checked regularly at the coumadin clinic and it well managed. We check her Glucose several times weekly at home and it is always normal. So, in the evening when her BP gets below 110 what does she do? Sometimes it is in the 90's. She is seen regularly by a Nephrologist and a Cardiologist but one cannot talk to them every day. She has been instructed to drink 80 oz of liquid daily. Her Cardiologist has cautioned about self adjusting the meds but what is she to do in the evening when her BP is under 110? She said that unless my wife is dizzy and unsteady do not adjust meds.

Answered by Dr. Sagar Makode (9 minutes later)

Brief Answer:
Amlodipine should be withheld in case of low BP

Detailed Answer:

Hi,

Lopressor is used for both heart rate and BP control. But, amlodipine is solely causing low BP. So if her BP is staying in lower range then her amlodipine dose has to be reduced.

So if her BP is less than say 115-120 systolic then amlodipine should not be taken as BP may go down with this. If BP is less than 100 then Lopressor should also be withheld as it can further decrease the BP. So overall, lowering the amlodipine dose and slightly increasing Lopressor to 100 mg should settle the issue. Our target for BP is 110 to 130 systolic and less than 85 diastolic for her.

Next, if BP is low then having coffee or salt sugar water will help in BP recovery. So you discuss these issues with the doctor. Have BP readings three times for a week and show the chart to the local doctor so as to make dose adjustments efficiently.

All the best.

Regards

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. Arnab Banerjee