We need my three sons here to design a computer program to figure out all these drug interactions along with the other medical problems that complicate the situation. Your b/p was something else!!!
1.) Salt Sensitive Test- I don't think the blood sodium reflects this. I know doing a 24 hr urine test is the closest way of figuring this out. I did my own test before I had HBP by taking away all salt for two months. Most salt comes from processed foods according to Dr. Edell. I don't add salt in cooking & cook from scratch. Anyhow I did not have a change in my b/p during that time.
2.) Ramipril - PDR says it works best with a thiazide diuretic.
3.) Spironalactone- Have you seen a b/p decrease since you started it? Researchers at U. of Ala. 0'3 in a study of 76 pts with R. HBP added 12.5-50mg Spironolactone along with an ACE or ARB. At 6 wks., there was a drop of 21/14mmHg. At 6 months, it went up to 25/12mg. The results occurred whether or not the pts had primary aldosteronism.
This drug has the potential for drug tolerance so it may not work in the future.
It converts some of the testosterone (women have this too) to a form of estrogen. Some pts taking this drug have developed breast cancer.
Aspirin interacts with this drug to increase blood potassium.
Licorice extract or candy will decrease the effectiveness of this drug.
This drug will increase the action of beta blockers. I know you said I believe that you couldn't take them because of your asthma.
Be cautious with impaired renal function or insufficiency.
3.) HCTZ
Whereas the PDR says be cautious with SEVERE renal function so I don't know if Spiro. is harder on the kidneys than HCTZ.
Uric acid (Gout) I'm taking 25mg HCTZ & my uric acid was 5.5mg (4.8-8.0) in 05' after being on the drug for about 1 1/2 yrs. I couldn't find my latest one from May but it was okay.
My Potassium was 3.9 mmol/L (3.6-5.1) in April. I find with eating 3-5 ser. of veg & 2 ser fruit plus 3-4 ser milk on a veggie diet that my potassium stays within range. I've gotten out of range twice because I was sick & didn't feel like eating. I didn't have to go to the hospital. I just started drinking orange juice & milk & other potassium rich foods & got it under control. Now I have a sick day diet to prevent this from happening again.
My sodium was 138 mmol/L (136-144mmol/L) in April.
I follow a low salt diet probably not as strict as you.
McGowan says 12.5 mg HCTZ is usually enough unless one has resistent or severe HPB. My other drug books say 25 mg is enough. Over that amount doesn't do more for hypertension unless you have edema like you just had.
So you could just cut back the dose of HCTZ to see what your b/p does then there would be less worry about Gout. There is a combo of HCTZ & Spiro. But since Spiro. is a weak antihypertensive & looks like it is worse on the kidneys, you might get away with just HCTZ.
I forgot that Dr. G. said that HCTZ isn't effective when creatinine (kidney test) is above a certain level. I can't remember what that level was but I'll try to find it. She is just saying when kidney function declines.
Just read phylox's post about uric acid-what I bummer. I was checking out my eczema on my hands .
Fam
Many thanks ...I have to go out and clear my head a bit and then read your post again. I am seeing my GP tomorrow so will have to decide whether or not I want to stay on the HCTZ and have a pefect blood pressure-113/80 this morning....or not...will reply later
I forgot that Dr. G. said that HCTZ isn't effective when creatinine (kidney test) is above a certain level. I can't remember what that level was but I'll try to find it. She is just saying when kidney function declines.
Thanks for digging up that info! At the moment, I have no doubt about the HCTZ effectiveness. (The numbers speak for themselves.. ) My kidney function is good (last checked for my edema) and I'd like to keep it that way...so what to do? It's so good to know my blood pressure CAN be controlled with certain drugs..if I can tolerate them and if they don't do more damage than good. I fear there may have been a good reason the BP doctor did not include HCTZ in his treatment.
Tommorrow I will ask for an rx for HCTZ. I LIKE having good blood pressure readings! My nephrologist would be happy to see them so low. I'll make sure to ask about increasing my salt intake. Worrying about gout will now replace my worries about high potassium levels. I will insist that my doctor check with the nephrologist to make sure he approves. Next, I'll phone the nephrologist's office myself and leave a message for the doctor about being on this medication and the dosage. (just to be sure). It's too bad we have to wait so long for appointments with our specialists. If I remember correctly, I had to wait 31/2 months for my last one. He might order a bunch of fancy testing over the phone just as he did in the past.
I'll also make sure to get my list of lab tests done, including serum uric acid - for what it's worth!
I just read up about Gout in the Merck Manual (Dr's Bible) latest edition. Preventative Rx with high fluid intake: Up to 3 liters per day for Gout pts. This prevents the uric acid from precipatating out in the kidney & causing damage. The diet only decreases the blood uric acid by 1 mg but it is worth a try if the values get high. I'm going to look back at my 01' labs to see what it was then before any meds.
Labs differ with their accuracy. Plus the problem is the test is not specific for Gout it says what ever that means. Have to think about that one. I would ask around to find someone in your area who has gout & get info from them concerning labs. I've had to ask my DR's to send stuff to another lab other than theirs because I was concerned about accuracy particularly regarding pap smears & the new Pap Test. Sounds like you have a good plan particularly regarding calling your Nep. Doc. I know its a pain with these specialists. I've gone through with that with the thyroid issues so he has given me guidelines for the disease if he is not available. Fam
Preventative Rx with high fluid intake: Up to 3 liters per day for Gout pts. This prevents the uric acid from precipatating out in the kidney & causing damage.
does the above mean a script for a specific drug WITH plenty of fluids or just a recommendation to drink a lot of water? I am not quite clear on that. Phlox mentioned a drug used as a preventative that's called Allopurinol (I wrote it down). I know that trying to control uric acid levels through diet alone would result only in a minimal reduction.
How would one go about finding a person with gout? Any recommendations? I can't even find anyone in my circle of friends and acquiantances with asthma. (Lucky me!) Thank goodness for message boards.
How is your thyroid, does it flare up or has it been taken care of?
You saw no change while there was no or low salt intake-does that mean that you are not a salt sensitive? I had this 24hr urine test done several times without anyone discussing the results with me...so maybe that's the reason for my sodium restriction?
Quote:
Ramipril - PDR says it works best with a thiazide diuretic
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The only diuretic I was put on was the Spironolactone and I am on 20mg Ramipril.
Quote:
Spironalactone- Have you seen a b/p decrease since you started it
Mine has been used with an ACE Inhibitor. And, briefly, the two ARBs, which I could not tolerate. Of course there was some reduction in BP. I was on five drugs so have no way of telling which ones worked and which ones did not. There was no consistency. Sometimes my BP was controlled and other times it was not. Since people develop tolerance to Spironolactone, it may have stopped working already. I think its main purpose was/is to keep more potassium in. (I did not know about my initially low potassium levels until recently). This drug stops women from menstruating and initiates breast growth in guys ... And, of course, it causes tumors in lab rats, which is something that everyone freely admits. It's not known whether it has the same effect in humans. (???) So how good can it possibly be for us? Why give it to patients? I might have to go back on the beta blockers, but not until the BP doc tells me to. They would have to be cardio-selective, because those are easier on people with asthma. I hope I'll do better on those than with the Labetalol.
As you suggest, I might get away with using just Hctz and dump the Spiro. It depends on the BP doc and on whether or not I can safely take this drug. I will certainly make my opinions known when the time comes. To answer your question, I think Spiro & the other drugs were selected to bump up my potassium levels. Or because of my kidney issues. I will ask the BP doc.
I think the Gout diet is doable because I'm doing most of it now. You are probably doing it too. Do you think that the uric acid test doesn't always reflect the amount of uric acid in the body because the extra uric acid has been deposited in the joints? A high uric acid doesn't always result in Gout. There is another uric acid preventive plus you can treat gout right away & avoid the problems. You may not get a high uric acid if you are able to take a lower dose of HCTZ, drop Spiro, & follow diet & other preventive stuff if you don't have a personal or family history of the disease. I made an error in the previous post. I have been on HCTZ since 6/04 instead 12 1/2 yrs. My uric acid has only increased 2mg & is still in the range with no symptoms.
You might try your Church (church bulletin ad), go to a senior center to find people with Gout. Or ask at a arthritis Dr. re: uric acid test.
I finally found that info about creatinine & diuretics. When the blood level is above 2.5mg/dl, these thiazide diuretics won't be effective. Cochline (spelling) is another preventive (Gout). Good luck tomorrow. Let us know what happens.
The 3 liters of water are to prevent the crystals of uric acid from forming in the urine. Helps flush uric acid out. Important to remember not to drink too much water at a time which will raise one's b/p. For example, 16oz of fluid drank in 15 min will raise one's b/p for two hrs. I sip 16 oz over an hour period while walking before breaksfast & supper. Fam
Did this fast HR start after starting HCTZ? A fast heart rate can occur if you drink too much too fast. I'll try to think of other reasons. How was your Dr's appointment? Fam
Yes, it normally is a very steady 65 -70. Since the HCTZ Í've gradually watched it rise into the 80s, then 90s and now 100s. When I woke up this morning it was just racing. Took my BP (excellent at 113/78) and the rate was 110 before I got out of bed.
The doctor was thrilled with my best ever BP reading in his office. Of course I am staying on the 50mg HCTZ, along with the 25'mg of Spironolactone and 20mg Ramipril. He knows I have stopped the CCB. As for the fast heart rate, he told me not to worry about it. It will return to normal after a while....(and, surprise surprise and what a coincidence..he'd had the exact same reaction many years ago when he himself first started taking it..very fast heartbeat..) Is he telling me the truth? I wonder..
I checked in my new drug reference book and it mentions only irregular heartbeat as a sign that too much potassium is being lost. I also went to get my prescription filled & talked to the pharmacist. She advised me to stop taking the pills if my heart rate did not get back to normal within a couple of days, in spite of what told by the doctor. (I'd mentioned it) She also thought I could use a product to improve my mineral & electrolyte balance - it's over 12 bucks and the main ingredient is salt. (I refused). In her opinion the fast heart rate could have been caused by dehydration. She then sent me for some Gatorade but I came back empty-handed. I could not find any sweetened with Aspertame. (I refuse to drink sugary stuff and I don't care what it is.) I am left wondering if a fast heart rate is fairly normal with this medication and nothing to worry about, as the doctor tells me. The pharmacist thinks the opposite.
I would bet on dehydration & possibly potassium (low). Did he do blood tests?
What color is your urine? Signs of dehydration: dark yellow urine, dry mouth, sticky saliva, fatigue, maybe thirst, nausea, vomiting followed by headache. If it is dehydration then you would assume that your potassium & sodium is probably low because they go out with the water. I would drink 16 oz orange juice slowly over a hour. Also, I would eat something salty even though you hate to do that to see if there is any change in your pulse.
Dr. Koop's (former surgeon general of US) rehydration recipe for pts over 12 is 1 quart of water with 1/2 tsp of salt & 3-4 tlbs of sugar. Under 12 yrs, one must use a commercial formulated drink. A rapid pulse would go with dehydration. You are on a big dose of a diuretic. Fam
I took your advice and am drinking OJ right now. I also ate a banana and had some water. Everything looks Ok, urine etc. My stomach feels weird all day (more than usual). It hurts a lot and there is nausea. I mentioned that to my doctor, too, and all I got was: would you like some Nexium?.... I answered no, thank you!
He said no lab tests were necessary today...so I'll bug him next week. He is not worried about my potassium levels at all due to Spiro. He says Spiro will balance any potassium loss out. I guess the main thing is that my kidney function is good. When I mentioned the uric acid testing, he was quick to point out that HE does not worry about getting gout...so I guess I should not either? Well, of course I do! But if the uric acid levels cannot be measured accurately, anyway, I guess there's not much we can really do to protect ourselves from having the crystals pop up in our feet. The report from the pulmonology function testing has not arrived yet so it will be dealt with next week (hopefully).
Thank you for your concern & your advice, I really appreciate it.
Flowergirl
Last edited by flowergirl2day; 07-23-2007 at 07:27 PM.
Flowergirl- Hi! I have read this thread with interest because I am thinking that HCTZ may be in my near future. I am watching my bp.
I noticed that you made a comment that you wouldn't have sugar only aspartame. You should do a search on the net. I have read in reputable sources that aspartame is considered a neurotoxin. This I thought was pretty widely known. I wouldn't get near the stuff and have just gone through a situation where I did drink Gatorade. I avoid sugar as much as possible but I needed the re-hydration. Please check out the info on aspartame , you seem like a health conscious person and this is one area that I think you would make a change in if you looked at the data.
p.s. after writing this message to you , I went to the net. I found the following- In l987 Emory Univ. Prof. of Ped. and Genetics testified before Cong. that Aspartame is a well known neurotoxin. Also lots of other stuff that sounds very bad- you be the judge.
Last edited by osteoblast; 07-25-2007 at 08:50 AM.
I am well aware of the toxicity of Aspertame. (I'll never get the spelling right!)My husband is a diabetic and likes his desserts. He goes through tons of artificial sweeteners in his coffee, cereal etc. I limit my use of the above to no-fat yogurt, which comes sweetened with it. I never drink any soft drinks or other liquids containing sugar or aspertame. I drink fruit juice only on occassion. I hardly ever bake anymore, so use very little Splenda. Thank you for the warning! It seems that one just can't win!
Osteo, have you researched natural ways of controlling hypertension? If yours is borderline this is the way to go! If necessary, don't be afraid to give the HCTZ a try. Most people don't experience what I just did.
Good luck!
Flowergirl
Last edited by flowergirl2day; 07-25-2007 at 09:04 AM.
thank you for your concern and for mentioning that congressional testimony. I am curious now as to what exactly was said so I'll see if I can find it in the archives.
I cannot convince my hubby to cut back on the amount of the artificial sweeteners he uses. I 'mentioned some of the negative comments to him but he does not care. Still goes through a lot. I, on the other hand, can easily stop myself from using it. When I run out of yogurt, I'll simply buy non-fat plain. I can always sweeten it with honey if the berries won't make it palatable enough.
Things are returning to normal in every way. The soreness in my left chest is gone, as of this morning. My pulse is slowly returning to normal, in high 70s resting today. My blood pressure is back to NORMAL. (that means good, bad, whatever, whenever ). Higher when I go to bed. (also normal). It does not spook me because I am used to it. I don't get my BP headache unless I hit 160's. I am on only two meds for the first time ever, a very low dose of Spironolactone and a high dose of Ramipril. Tracking my blood pressure is like playing a game (especially now) - you never know what you'll get. Too bad the stakes are so high.
I had a strange experience today, a first for me. I walked into a hair salon.....and started to sneeze...and sneeze...and sneeze...and sneeze. When I had everyone's attention, my sneezing turned into coughing. I then coughed...and coughed...and coughed some more. This went on for a short while. I thought I'd die from embarassement. (Is that possible?) I apologized to everyone as soon as I could. I guess all the hairsprays and chemicals in the air just got the best of me!
I am going to take my after dinner walk- with a bear bell this time. I usually bring it with me but forgot to last night. It gives the bears a fair warning to get lost (or stay lost).
Flowergirl
Last edited by flowergirl2day; 07-25-2007 at 06:25 PM.
...
I had a strange experience today, a first for me. I walked into a hair salon.....and started to sneeze...and sneeze...and sneeze...and sneeze. When I had everyone's attention, my sneezing turned into coughing. I then coughed...and coughed...and coughed some more. ...
Flowergirl
Hello Flowergirl,
Can't help but think it's the hctz that is now getting the best of you...you may experience more sensitivities to overthing now that you're on it. Remember my coughing fits? Haven't had them since I've been off of hctz.
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I will insist that my doctor check with the nephrologist to make sure he approves. Next, I'll phone the nephrologist's office myself and leave a message for the doctor about being on this medication and the dosage. (just to be sure). It's too bad we have to wait so long for appointments with our specialists. If I remember correctly, I had to wait 31/2 months for my last one. He might order a bunch of fancy testing over the phone just as he did in the past.
I might have to go back on the beta blockers, but not until the BP doc tells me to. They would have to be cardio-selective, because those are easier on people with asthma. I hope I'll do better on those than with the Labetalol. 
