Hello.
Thank you for posting your query.
I will need a few additional details to get a clearer picture.
What is your age? Do you have any other medical illness? What medicine did you take initially for hypertension, that led to water retention?
In your case since the BP is fluctuating, i will advise you to get an Ambulatory Blood Pressure Monitoring done. It will be helpful in finding the exact level of your BP, and based on that the treatment can be initiated. Ambulatory blood pressure is monitored, as the patient is required to wear a device that keeps taking the values every 30 minutes in the day time, and every 2 hours while sleeping. Then a data is generated based on the values over a period of 24-48 hours which finds the average of the blood pressure maintained through out the day, and is very accurate.
Inability to urinate along with high BP indicates kidney pathology, but since your MRA was fine, it is slightly confusing. If possible you can upload the reports. Did you get your RFT checked too?
Clouding of thoughts, fatigue, headache can all be attributed to high BP.
Hence it is better you get the ambulatory monitoring done as soon as possible. IT is good for diagnosis in people with fluctuant BP. For other patients, it is recommended that they get their BP checked over a period of time, for say one week, and based on those values a diagnosis is made. In your case this won't be helpful since your BP varies to a great extent and it can show confusing picture.
Hope this was helpful,
Regards.
Patient replied :
I have had all the typical blood work. I was not sent the results. The only thing not normal was my cholesterol it was high but my good cholestrerol was 91. I have had a calcium scoreing test and it was 0. I have always been healthy. I am 52 and in perimenopause currently having regular periods. I had stopped having persiods for about 3 months and my blood pressure increased quite a bit. I am a long distance biker and I mountain bike typicaly 5 hours a week in the summer. In the winter I strength train twice a week. The only time other then when I am on the blood pressure meds I have had big uninary issures was a biking trip. I rode 108 miles in 2 days. The second day the places that were supposed to have water did not at the last three hours. I was went from 9 am to 6:30pm with out urinating. Once I got off the trail and had dinner and drank lots of water. I was able to go but for about 2 days I carried an extra 4 to5 lbs. I am pretty good shape. I am 5' 2" and weigh about 150. The medications I have tried are
amlopine (i had hives along with the other issues with this med)
azilsartan less urininary side effect with this one but my blood pressure at times would drop to 98/55
losartan potassium
I have seen a cardiologist but the only thing they said was if the meds reduced my blood pressure I should take them no matter what. That is not very helpful since I almost cannot function when I am on them. I have three teenage boys at home that I need to be able paticipate with in what is goin on when I am on the meds iam unable to do that or to bike, concentrate at work, or urinate properly.
My reg suggested I see a kidney dr but at this point having had the MRA and sonogram of my kidneys, heart, adrenal glands. I am relectant to spend more time and money going in to specialist and having tests done. I have done everything the dr recomennd so far but at this point what I am doing is not working.
Hello.
Thank you for the follow up.
Also thank you for the additional information.
So what i understand from your history is that you have not tolerated the amlodipine ( Calcium Channel Blocker ) and Azilsartan well. CCBs or the first medicine that was given to you can at times cause water rentention and edema but that happens after a prolonged usage. Azilsartan is normally tolerated well and causes symptoms such as light headedness, and dizziness, but indeed it can bring down the BP by a large value.
In your case i truly feel you need the ambulatory BP monitoring. Once you get the values, it will make the picture much clearer. I can advise you to take Tab. Enalapril ( dose will depend on how high your values are ). It is normally the first line of treatment and very well tolerated with lesser risk of sudden hypotension as with Azilsartan. If your values are in the range of 160/100, Tab. Enalapril can be taken 5 mg once daily in the morning. And if your values are different dose can be modfied accordingly to suit you.
It would have been better if you could share your reports. I really believe Enalapril will help you. But please get the ambulatory BP monitoring done.
Regards.
Patient replied :
Thank you that ambulatory BD has never been suggested. I think it is becasue when ever I go in my blood pressure is 190's-200. I have tried to tell them it is not that high all the time but I get the impression that they do not think it should ever be that high. Typicaly it is only that high if I eat something salty or I am under any stress. I do not get stressed out very often but at this point going into the dr office is becoming stressful.
I go back in 9/4 I will talk to them then. I will ask about the RFT but I would be surprised if it was not done. If it was done and fine do you think I should still see a nephrologist?
Yeah since you have fluctuations, hence i suggested the ambulatory BP monitoring.
It will help in understanding if your BP is actually higher than normal at most times, or only when you're stressed.
If it increases only during stress and salty diet, then it is a good thing since both can be avoided. Stress can be effectively managed by yoga or other relaxing techniques such as meditation.
A lot of patients have this problem. Whenever they visit the doctor, due to the stress the BP shoots up immediately also famously known as the white coat hypertension. Again in this patients it is recommended that an ambulatory BP monitoring or a home based monitoring is done over a period of time to have conclusive results and not rely on what was checked in the doctor's office.
If your RFT is fine, then kidney causes can be ruled out. Since you have done MRA and sonogram, if there ws something the doctor would have told you and taken action accordingly. I don't feel there is a need to go to nephrologist, however a second opinion can definitely be taken. It will be great if you can get all your reports and upload.
Regards.