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Old 04-09-2012, 06:06 PM   #1
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Think I may be a low-renin hypertensive, ace-inhibitors raise my bp and pulse

Currently I haven't brought the issue up with my doctor as I am waiting for an appointment on the 27th. However I found this interesting article, as I have noted many people on this site have at times INCREASED blood pressure on ace-inhibitors.

http://www.sciencedaily.com/releases/2010/08/100819112222.htm

Essentially in low-renin hypertensives Ace-Inhibitors can actually INCREASE your blood pressure. Im not sure if this is my case but I have discontinued 2 different ace-inhibitors "Lisinopril, Ramipril" because they give me a dramatically increased pulse rate 100-105 when taking them and also give me spikes in my systolic blood pressure up to 170!

When taking my diuretic alone I still get occasional 145-150 readings on my systolic so I decided to experiment and take my old lisinopril bottle out, the results where pretty terrible. Overally I felt much worse on the lisinopril, my pulse was off the walls and I even got mild chest pains "though likely related to my anxiety".

I am waiting until my appointment to be prescribed any other anti-hypertensives, my last doctor felt that I should stay on the diuretic and stop taking bp for AWHILE, but I have become obsessed and dont want to die young. Unfortunately she was very open-minded, but has left for a better paying position upstate, and my other doctor is just king pharmaceutical "prescribed me 100mg Losartan and made me extremely sick". Im thinking of asking for the Losartan again just a more realistic dose such as 25, 50. Although is this low-renin affect also dangerous with ARBS?

Would like to see what atengnr has to say on this topic, I value his opinion even higher than my doctors at times.


If this is true, what drug should I ask for next? Currently I take 25mg hydrochlorothiazide, what if I took a potassium sparing diuretic together with it? I am trying to stay away from Betas and CCB's as I bicycle everyday about 2 hours and think this is likely a very healthy activity that I should not stop.

Last edited by dantescritic; 04-09-2012 at 06:08 PM.

 
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Old 04-13-2012, 08:38 PM   #2
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Re: Think I may be a low-renin hypertensive, ace-inhibitors raise my bp and pulse

I am not familiar with ACEIs raising BP in low-renin hypertensives. That being the case, I would expect an ARB to have a similar effect. Diuretics ought to be quite effective in such a case because of the tendency to reabsorb salt and water, which produces the low renin, would be well-opposed by the diuretic.

Didnt you have depressive symptoms that arose after trying an ARB in the past?

You could add a potassium-sparing agent to HCTZ, but these generally have little anti-hypertensive activity, more used to prevent low potassium levels in those taking diuretics.

You tried the dihydropyridine calcium channel blockers (amlodipine, nifedipine)? If not, I think theyre worth a try because they have almost no effect on cardiac function, and thus are less likely to alter your exercise capacity.

Keep in mind that my opinion is worth about 2 cents (or less)....

 
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Old 04-13-2012, 11:07 PM   #3
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Re: Think I may be a low-renin hypertensive, ace-inhibitors raise my bp and pulse

Quote:
Originally Posted by atengnr View Post
I am not familiar with ACEIs raising BP in low-renin hypertensives. That being the case, I would expect an ARB to have a similar effect. Diuretics ought to be quite effective in such a case because of the tendency to reabsorb salt and water, which produces the low renin, would be well-opposed by the diuretic.

Didnt you have depressive symptoms that arose after trying an ARB in the past?

You could add a potassium-sparing agent to HCTZ, but these generally have little anti-hypertensive activity, more used to prevent low potassium levels in those taking diuretics.

You tried the dihydropyridine calcium channel blockers (amlodipine, nifedipine)? If not, I think theyre worth a try because they have almost no effect on cardiac function, and thus are less likely to alter your exercise capacity.

Keep in mind that my opinion is worth about 2 cents (or less)....
Thanks aten, yep I did have a depressive effect on Losartan but at this point im considering taking a lower dose.. im just about out of options with the drugs. Maybe if I take 50 mg instead of the 100 mg I was taking I can avoid the depression?

The CCB's are a very interesting suggestion, I have not yet tried them and for one simple reason. CCB's mixed with diuretics apparently lead to pretty bad outcomes, sometimes just as bad as no treatment whatsoever.

http://www.theheart.org/article/1044871.do

At this point im considering just doing what one of my doctors suggested, remain on the HCTZ and re-check bp in a few months. But my mind just wanders back to my readings. At least it seems now that when I register high it is 145-150 systole instead of the 160-170 when I weighed 60 lbs more. My doctors wont even see me until the 27th and doesn't seem to think I am in an emergency situation, but im not convinced.

She thinks it is all WCE, again im just not convinced. Better be safe than sorry, eh?

Last edited by dantescritic; 04-13-2012 at 11:14 PM.

 
Old 04-14-2012, 07:34 AM   #4
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Re: Think I may be a low-renin hypertensive, ace-inhibitors raise my bp and pulse

I cant open your link, but I dont believe what you state is correct. A thiazide diuretic + a CCB would be a reasonable treatment option per the JNC 7 guideline.

Please fill me in if Im missing something regarding CCBs

 
Old 04-14-2012, 10:58 AM   #5
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Re: Think I may be a low-renin hypertensive, ace-inhibitors raise my bp and pulse

Quote:
Originally Posted by atengnr View Post
I cant open your link, but I dont believe what you state is correct. A thiazide diuretic + a CCB would be a reasonable treatment option per the JNC 7 guideline.

Please fill me in if Im missing something regarding CCBs
Chicago, IL - A new analysis of data from the Women's Health Initiative Observational Study shows that among the more than 30 000 women with uncomplicated hypertension in this cohort, treatment with the combination of calcium channel blockers and diuretics was associated with higher cardiovascular mortality than the combination of either beta blockers or ACE inhibitors with diuretics.

These observational findings cannot of course drive clinical recommendations, lead author Dr Sylvia Wassertheil-Smoller (Albert Einstein College of Medicine, Bronx, NY) told heartwire. "What they do is call for a clinical trial," she said. "The question you'd want to answer is, for people whose blood pressure is not controlled on diuretics alone, what is the next thing to add?"

They also report that taken as monotherapy, calcium channel blockers were associated with higher CVD mortality than diuretics, ACE inhibitors, or beta blockers taken alone.

The new report appears in the December 15, 2004 issue of the Journal of the American Medical Association.[1].

 
Old 04-14-2012, 11:16 AM   #6
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Re: Think I may be a low-renin hypertensive, ace-inhibitors raise my bp and pulse

I cannot comment on the progression of data since the time of this study, or even whether this study is considered to be valid, but there are several statements in this that no longer would be considered true. For one, as monotherapy, CCBs dont have higher mortality than the others, particularly beta blockers. Beta blockers have been shown to be the least effective, quite clearly.

How old is this trial? It seems that perhaps as old as the 1990s. One issue I recall was with the use of nifedipine, immediate-release, which was proven to increase risks. This drug isnt used for HTN anymore. One would have to dig into this study to be sure that it remains valid today, especially given its age, and some of the outdated comments noted.

 
Old 04-14-2012, 11:25 AM   #7
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Re: Think I may be a low-renin hypertensive, ace-inhibitors raise my bp and pulse

Just looking this up quickly, this was an observational study not a controlled trial. The drugs used were not noted in my quick search (key if it was the old formulation of nifedipine), as time frame was 1994-1998.

Id look for the experts opinion on this trial, as the interpretability of this is challenging IMO. Find if nifedipine non-XR was used. As note that this trial involved women aged 50-79 yoa.

Last edited by atengnr; 04-14-2012 at 11:41 AM.

 
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