Use of ACE Inhibitors or ARBs
addition to lowering blood pressure, ACE inhibitors and ARBs are
beneficial for both the kidneys and the heart. Many doctors will first
choose a medication from these two classes. If a patient of mine had
CKD, I would need a significant reason not to prescribe an ACE inhibitor
or ARB given their protective effects.
of these significant reasons is potassium level. If someone has high
potassium levels, she will not be able to take these medications. In
someone with advanced kidney disease (stage 4 or stage 5), using these
medications is like having a double-edged sword. While there are studies
that show they can delay the worsening of kidney function over time,
any stress on the kidneys - any type of serious illness, for example -
can worsen kidney disease in the presence of either of these two classes
of medications. There is also an increased risk of higher potassium
levels. Close monitoring of your kidney function and potassium levels
are required if you are placed on one of these medications.
the above factors are absent and someone has both diabetes and
hypertension, then these are the recommended classes of medications to
begin treatment with.
Use of Calcium Channel Blockers
addition to reducing blood pressure, calcium channel blockers also have
other beneficial effects. For instance, amlodipine (Norvasc), one
of the most studied medications, helps protect the heart and reduces
the risk of stroke. A major article has changed how many doctors are
using it to treat hypertension. If after first using either an ACE
inhibitor or an ARB the blood pressure remains high, amlodipine
(Norvasc) has been found to be a good second choice option. If you have
proteinuria, your doctor may instead choose either diltiazem
(Cardizem) or verapamil (Calan), as either of them can be used in
conjunction with an ACE inhibitor or ARB to reduce protein levels.
of medications prescribed from the calcium channel blocker class of
medications include amlodipine (Norvasc), nifedipine (Procardia),
felodipine (Plendil), and isradipine (DynaCirc). Moreover, diltiazem
(Cardizem) and verapamil (Calan) not only reduce protein levels, but
they are also used by heart doctors for the treatment of certain types
of arrythmia (a-rith-mia), or abnormal beating of the heart, because
they can slow the heart rate.
The main side effects of these medications include constipation and edema. Some patients may also complain of a mild headache.
Use of Renin Inhibitors
inhibitors represent the first new class of blood pressure medication
in years. They work by blocking the effects of renin. The only
medication in this class is aliskiren (Tekturna). It can also lower
urine protein levels, as documented in one study. One common side effect
is high potassium. Since it has only been out for a very short time,
its long-term effects need to be studied further.
Use of Beta Blockers
class of medications is used to lower blood pressure, and has found its
niche in those who have suffered a heart attack and those with
congestive heart failure. Examples of medications prescribed from this
class include metoprolol (Lopresor), atenolol (Tenormin), and nebivolol (Bystolic). Nebivolol (Bystolic) represents a newer class of beta blockers.
blockers can sometimes slow the heart rate, so it is important to take
your pulse in addition to monitoring your blood pressure. If your heart
rate is less than fifty-five, notify your doctor as he may need to make
medicine or dosing changes. Other side effects can include fatigue,
weakness, depression, and problems with libido. Call your doctor if you
experience any of the above symptoms.
average person takes several different medications. In an effort to
reduce the pill burden and increase compliance with medications, there
have been many single pill combinations created. One example is a
combination of both valsartan and hydrochlorothiazide called Diovan HCT.
Other examples include a combination of amlodipine and benazepril
called Lotrel, and a combination of olmesartan and amlodipine called
Azor. In the last two examples, an ACE inhibitor or ARB is combined with
a calcium channel blocker. These are very popular combinations often
used by physicians.
is both an upside and a downside to combination medications. If the
blood pressure is very high and very difficult to bring down, which can
happen in the setting of CKD, then two or more medications are often
needed. While using a combination medication decreases the quantity of
pills someone has to take, it there is a reaction to a medication, it
can be difficult to know which of the two medications is the culprit.
Also, giving two medications together may be too much at one time for
some people. If your doctor suggests that you begin taking a combination
medication, be sure to ask him about possible side effects as well as
interaction with other medications you may be taking. To find out more, you can check out Alternative Medicine For Kidney Disease.