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BP and KIDNEYS

bigsonbitch

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we all know how damaging high BP can be to your kids from use - especially over the years.
but i was wondering, at what reading will BP cause damage. if youre walking around with 140-90 for 10-15 years will that do it since its considered pre hypertention?

or does it have to be higher.(150-100 or higher) curious as i had high BP for years and just started addressing it within the past few years with meds
 

danieltx

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140 / 90 is considered stage 2 hypertension based on the latest guidelines released last year. Years of that is definitely not good for the kidneys.
 

bigsonbitch

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140 / 90 is considered stage 2 hypertension based on the latest guidelines released last year. Years of that is definitely not good for the kidneys.[/QU

whats funny is ive had docs always tell me 140-90 isnt too bad.
 

heavyhitter

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Any elevation over baseline for any sort of extended period of time will cause damage. It might not shorten your life expectancy of its just slight....but I would do what I could to control it as much as possible
 

suppdude

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Get your kidneys checked out and you’ll have your answer


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liquid_c

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I would if possible try to stay in the 130/80 range. 120/80 is much better. 140/90's a bit too high long term IMO. The lower you can keep it without getting dizzy the better.
 

bigsonbitch

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i had them checked in march - creatinine 1.13
bun 20
gfr 78
while on cycle

i was asking more in general than anything. i seem to see different opinions on this
 

little slice

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i was asking more in general than anything. i seem to see different opinions on this



you want your blood pressure between 110-120 over 70-80, generally speaking.



anyone who tells you otherwise, I wouldn't listen to them.
 

icedemon

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140 / 90 is considered stage 2 hypertension based on the latest guidelines released last year. Years of that is definitely not good for the kidneys.

Where did you see that 140/90 is stage 2 at? Here is what I have from 5 years ago.

< 120/80 Normal
120/80 - 139/89 Prehypertension
140/90 - 159/99 Stage 1 Hypertension
> 160/100 Stage 2 Hypertension
 

heavyhitter

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Where did you see that 140/90 is stage 2 at? Here is what I have from 5 years ago.

< 120/80 Normal
120/80 - 139/89 Prehypertension
140/90 - 159/99 Stage 1 Hypertension
> 160/100 Stage 2 Hypertension

You answered your own question. That's 5 years ago. They've changed the guidelines
 

bigsonbitch

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Where did you see that 140/90 is stage 2 at? Here is what I have from 5 years ago.

< 120/80 Normal
120/80 - 139/89 Prehypertension
140/90 - 159/99 Stage 1 Hypertension
> 160/100 Stage 2 Hypertension

American heart association changed the guidelnes - i still persoanlly think its to make more money for the drug companies
 

maldorf

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Lower in general is always going to be better for life expectancy. You just don't want it so low that you feel like shit. I have had that a few times and lowered my dose of heart meds to bring it back up. Once mine got down to around 85/45. Felt like shit. I feel best overall when mine is between 120/80 to 105/70 or so.
 

bigsonbitch

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Lower in general is always going to be better for life expectancy. You just don't want it so low that you feel like shit. I have had that a few times and lowered my dose of heart meds to bring it back up. Once mine got down to around 85/45. Felt like shit. I feel best overall when mine is between 120/80 to 105/70 or so.

maldorf,

what in your opinion are the best meds to lower BP. Im on 20mg lisinopril and 10mg norvasc, but it rarely gets below 120-80. im usually 120s-80s and often 130s -high 80s

i know being on def makes it tougher to lower it and i do cardio on stair master 4 times a week 30 min and im dripping sweat.
 

MyNameIsJeff

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American heart association changed the guidelnes - i still persoanlly think its to make more money for the drug companies


Yeah go on and parrot conspiracy theories without having even looked at the evidence. Don't mind the possibility that your bullshitting may dissuade people from seeking treatment, leading them to have a higher risk of cardiovascular disease. **EDIT**

Contribution To Literature:
The SPRINT trial showed that intensive BP control to SBP <120 mm Hg results in significant cardiovascular benefit in high-risk patients with hypertension compared with routine BP control to <140 mm Hg.

Description:
The goal of the trial was to compare the safety and efficacy of intensive lowering of systolic blood pressure (SBP) to <120 mm Hg versus routine management to <140 mm Hg.

Study Design
Patients were randomized to intensive SBP lowering (target <120 mm Hg) or routine SBP management (target <140 mm Hg).

Total number of enrollees: 9,361
Duration of follow-up: 5 years (median 3.26 years)
Inclusion criteria:

Age ≥50 years
Hypertension with SBP ≥130 mm Hg
At least one risk factor for heart disease:

Presence of clinical or subclinical cardiovascular disease other than stroke
Chronic kidney disease, defined as estimated glomerular filtration rate (eGFR) 20-59 ml/min/1.73 m2
A Framingham Risk Score for 10-year cardiovascular disease risk ≥15%
Age >75 years
Exclusion criteria:

An indication for a specific BP-lowering medication that the person is not taking and the person has not been documented to be intolerant of the medication class
Known secondary cause of hypertension
One-minute standing SBP <110 mm Hg
Proteinuria
Arm circumference too large or small to allow accurate BP measurement with available devices
Diabetes mellitus
History of stroke
Polycystic kidney disease
Glomerulonephritis treated with or likely to be treated with immunosuppressive therapy
eGFR <20 ml/min/1.73 m2 or end-stage renal disease
Cardiovascular event or procedure or hospitalization for unstable angina within last 3 months
Symptomatic heart failure within the past 6 months or left ventricular ejection fraction <35%
A medical condition likely to limit survival to <3 years or a malignancy other than nonmelanoma skin cancer within the last 2 years
Organ transplant
Principal Findings:
The trial was terminated early due to overwhelming evidence of benefit. The primary outcome, myocardial infarction (MI), acute coronary syndrome (ACS), stroke, congestive heart failure (CHF), or cardiovascular (CV) death, was significantly lowered in the intensive BP management arm compared with the routine management arm (5.2% vs. 6.8%, hazard ratio
0.75, 95% confidence interval [CI] 0.64–0.89; p < 0.0001).

Individual components (event rates for intensive vs. routine management, absolute event rates):

MI: 2.1% vs. 2.5%, p = 0.19
ACS: 0.9% vs. 0.9%, p = 0.99
Stroke: 1.3% vs. 1.5%, p = 0.5
CHF: 1.3% vs. 2.1%, p = 0.002
CV death: 0.8% vs. 1.4%, p = 0.0005
Important secondary endpoints for intensive vs. routine BP control, absolute event rates:

Mortality: 3.3% vs. 4.5%, p = 0.0003
Among patients with chronic kidney disease: composite renal endpoint (decrease in GFR ≥50%, need for HD, renal transplant); 1.1% vs. 1.1%, p = 0.76
Among patients without CKD: ≥30% decline in GFR to <60 ml/min: 3.8% vs. 1.1%, p < 0.001
Hypotension: 2.4% vs. 1.4%, p = 0.001
Syncope: 2.3% vs. 1.7%, p = 0.05
Hyponatremia: 3.8% vs. 2.1%, p < 0.001
Generalizability to the US population: Based on National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2012, it appears that 7.6% or 16.8 million US adults, and 16.7% or 8.2 million of those with treated hypertension, would meet the SPRINT eligibility criteria. Thus, 8.6 million of US adults are not currently treated for hypertension based on the SPRINT trial, highlighting the public health importance of these findings.

Among patients aged ≥75 years (n = 2,636), primary outcomes for intensive vs. routine BP management were 7.7% vs. 11.2%, p < 0.05. All-cause mortality was 5.5% vs. 8.1%, respectively, p < 0.05.

Left ventricular hypertrophy (LVH) progression (n = 8,164): Among participants without baseline LVH, intensive BP lowering reduced LVH on electrocardiogram (HR 0.54, 95% CI 0.43-0.68). Similarly, among participants with baseline LVH (n = 605, 7.4%), intensive BP lowering was more likely to show LVH regression (HR 1.66, 95% CI 1.31-2.11). Adjusting for LVH did not attenuate the risk of CV disease with intensive lowering, suggesting that LVH improvement was not a significant driver of CV disease reduction with intensive BP lowering.

Effect on patient-reported outcomes: Patient-reported outcome measures included the scores on the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Veterans RAND 12-Item Health Survey, the Patient Health Questionnaire 9-item depression scale (PHQ-9), among others. Participants who received intensive treatment received an average of one additional antihypertensive medication, and the systolic blood pressure was 14.8 mm Hg (95% confidence interval, 14.3-15.4) lower in the group that received intensive treatment than in the group that received standard treatment. Mean PCS, MCS, and PHQ-9 scores were relatively stable over a median of 3 years of follow-up, with no significant differences between the two treatment groups. Satisfaction with BP medications was high.

Cost-effectiveness: A microsimulation model was created to assess costs, clinical outcomes, and quality-adjusted life-years (QALYs) among SPIRIT-eligible adults. The mean number of QALYs was estimated to be 0.27 higher among patients who received intensive control than among those who received standard control and would cost approximately $47,000 more per QALY gained if there were a reduction in adherence and treatment effects after 5 years; the cost would be approximately $28,000 more per QALY gained if the treatment effects persisted for the remaining lifetime of the patient. Most simulation results indicated that intensive treatment would be cost-effective (51-79% below the willingness-to-pay threshold of $50,000 per QALY and 76-93% below the threshold of $100,000 per QALY), regardless of whether treatment effects were reduced after 5 years or persisted for the remaining lifetime.

BP measurement differences: A post hoc survey was conducted at SPRINT closeout sites as to whether BP measurements were usually attended or unattended by staff. Patients were divided into four groups: always alone, never alone, alone for rest, and alone for BP measurement. Improvements in primary endpoint and total mortality with intensive BP lowering were similar between these four groups (p for interaction for primary endpoint = 0.88), suggesting that the results were insensitive to whether or not patient BP measurements were made in an attended fashion.

Interpretation:
The results of this landmark trial indicate that intensive BP lowering to a target <120 mm Hg is superior to routine management with a target of <140 mm Hg in high-risk nondiabetic patients with hypertension, including in elderly patients. There were also reductions noted in CV and all-cause mortality, accompanied by a reduction in CHF. An intensive strategy also reduced the risk of developing LVH among patients without baseline LVH and resulted in greater LVH regression among those with evidence of baseline LVH. An intensive strategy carried a higher risk of hypotension, syncope, and accelerated reductions in GFR (only in patients without CKD at baseline). This is a landmark trial and is likely to result in a paradigm shift in the management of patients with hypertension.

The trial design is also interesting because it suggests that hypertension treatment should be individualized based on underlying risk of CV outcomes rather than based on absolute values alone. This change has occurred in lipid management as well, based on the most recent Eighth Joint National Committee (JNC 8) guidelines. The public health importance of this trial will be large. These findings are contrary to the smaller ACCORD trial in patients with diabetes mellitus, where aggressive BP lowering was not associated with superior CV outcomes.


https://www.acc.org/latest-in-cardiology/clinical-trials/2015/09/23/10/40/sprint
 
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suppdude

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Do you do any cardio?


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maldorf

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maldorf,

what in your opinion are the best meds to lower BP. Im on 20mg lisinopril and 10mg norvasc, but it rarely gets below 120-80. im usually 120s-80s and often 130s -high 80s

i know being on def makes it tougher to lower it and i do cardio on stair master 4 times a week 30 min and im dripping sweat.

Well, I take Lisinopril and Bisoprolol. Lisinopril I use just 10 mg, was on 20 when bp was too low. The bisoprolol is a beta blocker and really the only reason I use it is to slow down my heart rate. I don't think you would need that unless your heart is in bad shape like mine.

A beta blocker like Coreg would probably be better since it brings down BP more. It isn't as cardioselective and affects vasodilation more in your circulatory system to bring down BP.

Im not familiar with Norvasc, but just looked it up to see its a Ca ++ channel blocker and used for high bp. That sounds better to me than a beta blocker. I don't think you really need a beta blocker.

Youre with a doctor now that is trained for all of this. If he is a cardiologist then I would really listen to him. If he is not then you might want a second opinion and see a cardiologist. If your bp is sometimes in the 130s and high 80s that would really just be boarderline and certainly not something to freak out about. I do think though that many years being like that might lessen your lifespan some. Ask your doctor about maybe raising your dose some and keep an eye on your BP to see where it goes. If it drops down below 120/80 then that is great, and just be sure you feel well once it is down.

One trick I have learned when taking BP meds, you have to SLOWLY increase the dose otherwise youll feel like crap. It might take several months to reacclimate. For instance, for two days take 20 mg lisinopril and then the 3rd day take 30 mg (break a pill in half), then 2 more days of 20 mg, then a day of 30 mg. Do that for 2 or 3 weeks and then go to EOD 30 mg. Eventually youll be taking 30 mg/day. If it isn't too low then you can work up higher.


I don't know how high they like to go on Lisinopril, if 20 mg is at the top then the doc might have you change your other drug, the Ca++ channel blocker. The key is to do it slowly and methodically.
 

little slice

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One trick I have learned when taking BP meds, you have to SLOWLY increase the dose otherwise youll feel like crap. It might take several months to reacclimate. For instance, for two days take 20 mg lisinopril and then the 3rd day take 30 mg (break a pill in half), then 2 more days of 20 mg, then a day of 30 mg. Do that for 2 or 3 weeks and then go to EOD 30 mg. Eventually youll be taking 30 mg/day. If it isn't too low then you can work up higher.



I doubled my lisinopril dose overnight (20mg to 40mg) and I never felt bad
 

maldorf

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I doubled my lisinopril dose overnight (20mg to 40mg) and I never felt bad

Just depends on how much it affects your bp. If your bp drops a lot it will. For some reason that drug must not have affected your bp much or maybe it was pretty high to begin with and never got very low.

You need to report your before and after numbers.
 

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