In 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.
One 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.
If 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
In 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.
Examples 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
Renin 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
This 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.
Beta 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.
Medication Combinations
The 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.
There 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.