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Diagnosed with BP induced persistent Afib and recently with CHF, EF=30%, BP 200/100 give or take. Now, 4 weeks into aggressive plant food based lifestyle, having lost 17 pounds (current weight 230 pounds, 5'10" tall), BP is unchanged. I take furosemide, metoprolol and ramipril. No signs of edema or fluid on the lungs at yesterdays check-up. My question: Could the persistent hypertension be caused by water retention in the circulatory system?
Thank you in advance

Patrick Hen

Category: Cardiologist

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Category: Cardiologist
Dr. Vivek Mahajan is online now

Expert:  Dr. Vivek Mahajan replied 4 Days.

Hello. Thank you for your query at
Your starting blood pressure is 200/100. It is likely that 3 to 4 or even 5 drugs maybe required to control it.
Ofcourse salt and water retention can be a mechanism. Renin-angiotensin-aldosterone system gets activated and causes salt and water retention. However, in your case you are already on a diuretic and ramipril which are supposed to counter that mechanism.
So it needs to be checked whether the doses received by you are adequate and whether they can be further increased.
You should have a salt restricted diet. If the 3 drugs that you are taking in maximal doses does not conrrol your blood pressure, then it is called resistant hypertension and a 4th drug needs to be added. That should be a calcium channel blocker like amlodipine or cilnidipine.
If that too fails then we shall have to add a potassium sparing diuretic like eplerenone and it becomes refractory hypertension. In that case you need to be investigated for secondary causes of hypertension like renal artery stenosis hyperaldosteronism etc.
We have a second line of anti hypertensive agents if these 5 drugs fail.
At this stage we need to ensure that the doses you are receiving are adequate and you are regular with them and also if you are having a salt restricted diet.
Feel free to discuss further.
Regards, Dr Vivek Mahajan,
MD Medicine,
DM Cardiology.

Dr. Vivek Mahajan
Category: Cardiologist
Fellowship: DM, Cardiology, PGIMER, 2013
Residency: MD, Internal Medicine, AIIMS, 2007
Internship: King Edward Memorial (KEM) Hospital, 2003 
Medical School: MBBS, Seth G.S. Medical College, 2002
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