Experience 35 years of experience in the field of nephrology & hypertension. Emeritus Professor of clinical Medicine at a major medical school and director of Nephrology & Hypertension at a university affiliated medical center.
Question QUESTION: Currently I am on 150 mg Tenormin & blood pressure is still high. Blood test & echogram have been done to determine the kidney is functioning okay. Am 70 yrs old, had left double kidney removed at 24. (right enlarged of course)
The doctor just added 10 mg. of Lisinopril which I have not started & after reading your very good answer to Eric, am almost afraid to do so. How is one tested for renal blood flow to make sure kidney circulation is okay? Do you think this is necessary in my case? Have been on a low dose of Tenormin for 20 yrs after thyroid was removed. Lately my BP has gotten worse. Hense, the uppage to 150 mg. They talk about increasing it to 200mg, but if 150 is doing no good, how can 50 more mg help?
Thank you for any information.
ANSWER: Dear Barbara,
It is certainly possible for an individual in their 70's to have a narrowing of the artery to the kidneys (renal artery stenosis) (especially in a solitary kidney) and have it cause or exacerbate existing hypertension. In such a case, however, it would be unlikely that your remaining kidney would remain enlarged since it would generally shrink when its blood supply is impaired. But, renal artery stenosis should be excluded with a DOPPLER RENAL ARTERY ULTRASOUND. If this is normal that abnormality would be unlikely.
150 mg of tenormin a day is a whopping dose of beta blocker and can result in a measurable amount of weakness and a general diminution of your overall sense of well being (called the "beta blocker blues"). It would be nice to get you on a lower dose or at least not have to raise the dose any further. Therefore, I think adding lisinopril is an excellent idea. When this is done, however, your kidney function MUST be monitored very closely because if you did have renal artery stenosis, your creatinine would rise precipitously. Creatinine is a kidney function blood test and rises when the kidneys fail to filter the blood properly. A rise in the creatinine when an ACE inhibitor (lisinopril) is administered to a patient with a solitary kidney is good physiologic evidence of renal artery stenosis. This effect is quickly reversible when the ACE inhibitor is discontinued.
I would add lisinopril 5 mg/day to your medicinal regimen and increase the dose by 5 mg every two weeks until your BP is less than 140/90 or the dose reaches 20 mg/D. If you need further medication I would add hydrochlorthiazide (HCTZ) 12.5 mg/D increasing to 25 mg max. If further medication is needed I would add amlodipine. As you can see, the principle in treating hypertension is to prescribe smaller doses of multiple drugs hoping to avoid or at least minimize side effects. It is unlikely that you will need all of these meds but nearly always, two or three are needed to get the BP less than 140/90. I like mine less than 120/70 and that's where it is on 10 mg of lisinopril daily.
I would do the above and not increase the tenormin at this time .
Hope this is helpful to you and not too confusing.
Sincerely,
DR. Falkinburg
---------- FOLLOW-UP ----------
QUESTION: Dear Doctor,
Want to thank you for your very prompt answer to my first question. I started 5mg of lisinopril daily & wiil up it soon to 10mg. Am still on 150mg of Tenormin. Understand will have to wait 2 or 3 weeks to see an improvement.
My BP will be 140/93 & then in the late afternoon or evening will spike to 182/126 as it did today. I took a benedyrl & klonopin to bring it down..last reading 131/98.
Can allergies cause it to spike like this? Could it have anything to do with my cortisol levels going up in the afternoon/evening?
Your answers are really appreciated and a big help to me & ater reading your answers to others; am sure many people have been helped by you.
Thank you.
Barbara
Answer Dear Barbara,
Benadryl is an antihistamine medication used to treat allergies. It has no place in the therapy of hypertension. In fact, it can cause and aggravate hypertension. Allergra or loratidine would be a better choice that has minimal effects upon blood pressure.
Cortisol levels are ebbing in the evening. They are hoghest in the early AM....around 6 AM if I remember correctly. So, "NO" cortisol is an unlikely culprit but the benadryl isn't.
