BP Meds possibly linked to kidney damage

[qbkilla]

The problem with kidney health, is that there's no reliable way to spot damage before your kidneys have started declining.

I'd say protein in urine and a ride in creatinine over time may give us some info .

I'd also wonder if bp meds are directly harming kidneys or all the things people do that get their BP out of range to where they need to be on meds damage the kidneys.

 

[Soalian]

I'd say protein in urine and a ride in creatinine over time may give us some info .

I'd also wonder if bp meds are directly harming kidneys or all the things people do that get their BP out of range to where they need to be on meds damage the kidneys.

Kidney damage from high BP doesn't seem to be immediate, but cumulative over time (years), barring any acute hypertensive injury/emergency, where one episode might cause AKI, then possible enhanced suceptibility and further progression to kidney disease.

Any AAS user should read the following study IMO:

Pathophysiology of Hypertensive Renal Damage

Especially, high BP and influence on kidney health is a huge point of concern for people like me, who naturally have addictions and is powerfully drawn to AAS use and stim use (often concurrently)

 

[tornquad201]

I’ve been on olmesartan + amlodepine for a year now and saw my creatinine rise (and thus GFR decline). Those markers were always perfect pre medicating. It isn’t dramatic yet but no one likes to see markers deteriorate.

Ace inhibitors raise creatinine but is it a side effect of taking the medication vs actual kidney damage .

 

[Soalian]

"My man" I do not think these drugs are "the deeeeeeevillllll" at all. I think it's bad to promote them for healthy men as a prophylactic because there are risks that also should be considered:

Please refer to:

American Society of Health-System Pharmacists 2014; Drug Information 2014. Bethesda, MD. 2014, p. 2073:

"Symptomatic hypotension may occur in patients with an activated renin-angiotensin system (e.g., patients with volume or salt depletion secondary to salt restriction or prolonged diuretic therapy)...

"Because the RAAS appears to contribute substantially to maintenance of glomerular filtration in patients with congestive heart failure in whom renal perfusion is severely compromised, renal function may deteriorate markedly (e.g., renal failure) in these patients during therapy with an angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor antagonist (e.g., telmisartan)...

"Renal artery stenosis also is a risk factor for renal impairment during therapy with drugs that inhibit the RAA system. Although reports received to date have involved patients treated with ACE inhibitors, this adverse effect also would be expected to occur when drugs with similar pharmacologic activity (e.g., angiotensin II receptor antagonists) are used in a similar manner."

LiverTox (NIH):
Telmisartan has been associated with a low rate of serum aminotransferase elevations (Likelihood score: E* (Unproved but suspected rare cause of clinically apparent liver injury).

https://www.ncbi.nlm.nih.gov/books/n/livertox/Telmisartan/


NIH; DailyMed. Current Medication Information for MIicardis (Telmisartan) Tablet (Revised: October 2012). Available from, as of October 9, 2014: https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=cfb9309f-e0df-4a55-9542-0e869fce05fb
"Hyperkalemia may occur in patients on angiotensin II receptor blockers (ARBs), particularly in patients with advanced renal impairment, heart failure, on renal replacement therapy, or on potassium-containing supplements, diuretics, salt substitutes or other drugs that increase potassium levels. Consider periodic determinations of serum electrolytes to detect possible electrolyte imbalances..."

Anyone presenting these drugs as risk-free PPARgamma (lulz) modulators and great for fluid retention (oh btw they're blood pressure and diabetic nephropathy meds) is, frankly, dangerous.

had similar episode happen earlier this year, BP was constantly hovering around 140/90 on most days;

so I was prescribed Ramipril initially at 5mg, didn't lower BP much the first week, then took 10mg daily for two weeks.

Was ok at first, then I started having typical 105-110/60-70 blood pressure daily, with itching and calf cramps, feeling quite lethargic too; had 100/63 BP for an entire day, then decided to temporarily drop the Ramipril.

Didn't make the connection at the time, that i was on ketogenic diet in the meantime, therefore I think my salt intake was insufficient, and I might have suffered from indirect diuretic effects from the ketogenic diet, which added to the BP lowering on top of the Ramipril.

Subsequent bloold test panels for kidneys revealed about 20% lower GFR than the month prior, but that might have been expected because ACEi/ARBs are supposed to lower GFR.

Some will say 100/60 is not hypotension level; my concerns were that I might have suffered from some ischemic renal damage, due to insufficient renal blood flow from the sudden hypotension.

In the litterature more intense and aggressive BP lowering has been showed to possibly lead to faster GFR decline over time, and ischemic kidney damage in hypertensive subjects, given the incomplete renal autoregulatory vasolidatory response of the pre-glomerular microvasculature, to the intensive and maybe sudden BP lowering interventions, thus leading to insufficient renal blood flow over time and ischemic episodes (also the problem seen in renal artery stenosis).

 

[Type-IIx]

had similar episode happen earlier this year, BP was constantly hovering around 140/90 on most days;

so I was prescribed Ramipril initially at 5mg, didn't lower BP much the first week, then took 10mg daily for two weeks.

Was ok at first, then I started having typical 105-110/60-70 blood pressure daily, with itching and calf cramps, feeling quite lethargic too; had 100/63 BP for an entire day, then decided to temporarily drop the Ramipril.

Didn't make the connection at the time, that i was on ketogenic diet in the meantime, therefore I think my salt intake was insufficient, and I might have suffered from indirect diuretic effects from the ketogenic diet, which added to the BP lowering on top of the Ramipril.

Subsequent bloold test panels for kidneys revealed about 20% lower GFR than the month prior, but that might have been expected because ACEi/ARBs are supposed to lower GFR.

Some will say 100/60 is not hypotension level; my concerns were that I might have suffered from some ischemic renal damage, due to insufficient renal blood flow from the sudden hypotension.

In the litterature more intense and aggressive BP lowering has been showed to possibly lead to faster GFR decline over time, and ischemic kidney damage in hypertensive subjects, given the incomplete renal autoregulatory vasolidatory response of the pre-glomerular microvasculature, to the intensive and maybe sudden BP lowering interventions, thus leading to insufficient renal blood flow over time and ischemic episodes (also the problem seen in renal artery stenosis).

Yes bro, it sounds like you were suffering from at least a couple of the deleterious effects that can be produced by ARBs/ACE inhibitors.

I'll repost from another thread the indicated use for these medications: [link 1] [link 2]:

ARB or ACE inhibitor use may be indicated if:

BP is 140/90 if taken at the doctor's office, 135/85 if taken at home. It's also far more advisable to cycle off/reduce dose and make lifestyle changes before the addition of an ARB. Though if higher than 160/100, immediate drug treatment is indicated (as is an urgent call to the doc & cessation of drugs).

Monitoring health parameters with the use of ARBs/ACE inhibitors:

Do a blood test before and one month after starting (or after an increase in dose), and if everything comes back normal, every half a year. Include creatinine, eGFR and electrolytes. (There are a lot of guidelines with regard to monitoring, but there isn’t too much consensus about it.) Please keep in mind that it takes about 4 to 6 weeks for the full effect of treatment. Ideally you reach a blood pressure below or equal to 130/80 mmHg (but above 120 mmHg).

Peter Bond, Article, Jul 2021, Measuring and Treating High Blood Pressure in Anabolic Steroid Users

 

[Soalian]

Yes bro, it sounds like you were suffering from at least a couple of the deleterious effects that can be produced by ARBs/ACE inhibitors.

I'll repost from another thread the indicated use for these medications: [link 1] [link 2]:

ARB or ACE inhibitor use may be indicated if:

BP is 140/90 if taken at the doctor's office, 135/85 if taken at home. It's also far more advisable to cycle off/reduce dose and make lifestyle changes before the addition of an ARB. Though if higher than 160/100, immediate drug treatment is indicated (as is an urgent call to the doc & cessation of drugs).

Monitoring health parameters with the use of ARBs/ACE inhibitors:


Peter Bond, Article, Jul 2021, Measuring and Treating High Blood Pressure in Anabolic Steroid Users

yeah, minimum BP I measured at home was 100/63, so still lower end of normal blood pressure, from about 140/90 two weeks prior;

I'm not so worried about the low BP levels with ACEi use, so much as the rapid and sharp drop from stage II hypertension levels to those levels in only a matter of days, at least it showed the meds were effective.

Only confounding factor was I'd just started a ketogenic diet at the time, messed up salt intake a bit (mild salt reduction), so net effect might have been even more BP lowering due to the diuretic effects of salt restriction on keto.

 

[Type-IIx]

yeah, minimum BP I measured at home was 100/63, so still lower end of normal blood pressure, from about 140/90 two weeks prior;

I'm not so worried about the low BP levels with ACEi use, so much as the rapid and sharp drop from stage II hypertension levels to those levels in only a matter of days, at least it showed the meds were effective.

Only confounding factor was I'd just started a ketogenic diet at the time, messed up salt intake a bit (mild salt reduction), so net effect might have been even more BP lowering due to the diuretic effects of salt restriction on keto.

Yes, absolutely a factor to be considered.

 

[Soalian]

Yes, absolutely a factor to be considered.

All in all this thread made me rethink indiscriminate and ad libitum ACE/ARB use in AAS users a bit (also because some AAS users want to go "better safe than sorry" route and see anti-hypertensive meds as inocuous, sometimes they add diuretics on top of that,etc,...)

 

[Soalian]

Yes, absolutely a factor to be considered.

btw what do you think lower threshold for acceptable BP should be on the long term? Like the optimal BP levels we should target to achieve in ourselves as AAS users?

 

[Type-IIx]

btw what do you think lower threshold for acceptable BP should be on the long term? Like the optimal BP levels we should target to achieve in ourselves as AAS users?

120/80 mmHg

 

[Soalian]

120/80 mmHg

From the limited body of evidence I've gathered, I think the optimal antihypertensive regimen for AAS users (lifestyle and drugs) wouldn't include any diuretic in particular (I'd be suggesting AAS users kept track of their sodium intake though):

- BP goals 110-125/70-85

- Mandatory daily LISS Cardio minimum 30mn

- Telmisartan (80-160mg) + Nebivolol (5mg) combination

- Ancillary supps (Fish oil/CoQ10/Garlic/...)

- Monitor BP daily morning/night at home



What else should we add?

 

[Type-IIx]

From the limited body of evidence I've gathered, I think the optimal antihypertensive regimen for AAS users (lifestyle and drugs) wouldn't include any diuretic in particular (I'd be suggesting AAS users kept track of their sodium intake though):

- BP goals 110-125/70-85

- Mandatory daily LISS Cardio minimum 30mn

- Telmisartan (80-160mg) + Nebivolol (5mg) combination

- Ancillary supps (Fish oil/CoQ10/Garlic/...)

- Monitor BP daily morning/night at home



What else should we add?

Emphasis must be on the user actually being hypertensive.

Then, setting aside mandatory LISS (that should be in any antihypertensive regimen, even if not hypertensive).

Follow the instructions above indicating for use of an ARB/ACE inhibitor (e.g., telmisartan).

Beta blockers like nebivolol are not indicated unless resting HR & BP are very high. Even then, they just suck for bodybuilders and affect training and effort substantially. Take those sparingly, away from training.

Supps are eh, sure, take whatever they're touting, I think fish oil is the likeliest to influence CV risk.

 

[Type-IIx]

Of all the beta blockers, I do prefer nebivolol though. It would combine well with hypertensive long-term rhGH users & with high dose clen.

 

[Soalian]

Emphasis must be on the user actually being hypertensive.

Then, setting aside mandatory LISS (that should be in any antihypertensive regimen, even if not hypertensive).

Follow the instructions above indicating for use of an ARB/ACE inhibitor (e.g., telmisartan).

Beta blockers like nebivolol are not indicated unless resting HR & BP are very high. Even then, they just suck for bodybuilders and affect training and effort substantially. Take those sparingly, away from training.

Supps are eh, sure, take whatever they're touting, I think fish oil is the likeliest to influence CV risk.

Thanks, yeah I don't take Nebivolol.

As an aside, do you think it's possible to experience kidney disease and uremic symptoms with eGFR 70-72?

eGFR was 95 about a year ago, no changes in lifestyle, nutrition, etc,..., except for a Ramipril course that I stopped in February.

Now my eGFR has been tested twice, mid-April, and end of June, 70 and 72 eGFR numbers came back, no protein in urine, cr/albumine ratino is good.

However I've been having regular generalized pruritus, more pronounced and sometimes metallic taste in mouth for weeks now, stopped most of my supps now.

GP doesn't seem to give it a lot of thought, I'm slated for new round of blood panels soon, to try to disentangle the issue.

I had at least one AKI episode in the past though.

Sound like potential symptoms of CKD, however don't know how likely it it, this is what I experience right now, given my eGFR levels atm.

 

[whacked]

^^^

Have you put on more muscle over the last year? This will increase your creatinine levels and thus, lower eGFR

Were you properly hydrated when you tested your eGFR? Not being will also skew numbers adversely.

Lastly, despite your drop, you are still in a decent / normal range so I would highly doubt any “kidney function” sides are occurring.

A 24-hour creatine clearance test is much more accurate than a serum/blood test (eGFR).

 

[Soalian]

I’ve been on olmesartan + amlodepine for a year now and saw my creatinine rise (and thus GFR decline). Those markers were always perfect pre medicating. It isn’t dramatic yet but no one likes to see markers deteriorate.

doesn't mean actual renal damage, eGFR reduction from ARBs/ACEs may only reflect hematological changes induced by those drugs (efferent arteriolar vasodilation, lowered intraglomerular pressure,... )

 

[MyNameIsJeff]

Thanks, yeah I don't take Nebivolol.

As an aside, do you think it's possible to experience kidney disease and uremic symptoms with eGFR 70-72?

eGFR was 95 about a year ago, no changes in lifestyle, nutrition, etc,..., except for a Ramipril course that I stopped in February.

Now my eGFR has been tested twice, mid-April, and end of June, 70 and 72 eGFR numbers came back, no protein in urine, cr/albumine ratino is good.

However I've been having regular generalized pruritus, more pronounced and sometimes metallic taste in mouth for weeks now, stopped most of my supps now.

GP doesn't seem to give it a lot of thought, I'm slated for new round of blood panels soon, to try to disentangle the issue.

I had at least one AKI episode in the past though.

Sound like potential symptoms of CKD, however don't know how likely it it, this is what I experience right now, given my eGFR levels atm.

You seem to have an unhealthy obsession with your kidney function, bordering on hypochondria. Based on what you report, your kidneys are perfectly healthy, making it exceedingly unlikely that your pruritus is related to kidney disease. Continue to investigate other potential causes (cholestatic, hematologic, endocrine). If no cause can be identified, consider psychosomatic disorder: https://www.sciencedirect.com/science/article/abs/pii/S016383430800042X

 

[mike036]

You seem to have an unhealthy obsession with your kidney function, bordering on hypochondria. Based on what you report, your kidneys are perfectly healthy, making it exceedingly unlikely that your pruritus is related to kidney disease. Continue to investigate other potential causes (cholestatic, hematologic, endocrine). If no cause can be identified, consider psychosomatic disorder: https://www.sciencedirect.com/science/article/abs/pii/S016383430800042X

Good to see you posting again @MyNameIsJeff

 

[whacked]

Good to see you posting again @MyNameIsJeff

x2

 

[Bobik]

Good to see you posting again @MyNameIsJeff

x3