Hypertension and Chronic Kidney Disease

Dear Ask The Doctor: Hello, I am a female with severe hypertension and nephrosclerosis. About 4 months ago my kidney function started to decline rapidly, dropping from the usual 40s to 20s. I had to stop all but 3 or 4 of my medications. For months prior to this, my blood pressure stayed very low on medication, 80s over 50s, symptomatic and low enough to worry me, well bellow a treatment goal of 110 over 70. I was on three diuretics at the time, as well as other blood pressure and other medication. Stopping the drugs resulted in an immediate improvement. However, the antihypertensives I have been taking since, two diuretics and a beta blocker, do not adequately control my blood pressure, which remains, in my opinion, too high for someone like myself with CKD. It has been in the 150s over 90s and goes higher of course. My family physician, though he monitors my progress closely, has not made any adjustments to my drug regime, saying that higher blood pressure seems better for my kidneys and that he does not want to risk the blood pressure getting too low. I will not be seeing my nephrologist for a few more weeks. I know that my nephrologist's as well as family physician's number one priority has been to keep the blood pressure well controlled. My question is: how safe is it to keep the blood pressure at these levels? Is having a higher blood pressure the lesser of two evils here? I worry about stroke, as there is a strong presence of carotid atherosclerosis in my family. Thank you for your input.

Dear Vlasta:

Certainly having a high blood pressure is not good for your kidneys nor having too low blood pressure, however in my opinion, surely your physician is observing before changing your blood pressure medications, possibly using ACE inhibitors trying to keep your systolic blood pressure between 130-140.

Let me reassure that your blood pressure is borderline high, it might be considered a risk factor for other cardiovascular conditions especially if you have a family history however there are other factors that would need to be present as well and you  might be able to correct. Weight loss, exercise and avoiding salt completely would help you decrease your blood pressure. I would suggest you that in your next doctor’s appointment check your cholesterol levels and depending on the lab values and your cardiovascular history your doctor might prescribe you children’s aspirin as a prophylactic. I wish you the best.