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BP not controlled. Cervical spine stenosis, Right renal agenesis - Online Doctor Chats

Date : 13-Jan-2012
User rating for this question
Very Good Posted in: Kidney Conditions
Answered by

General & Family Physician
Practicing since : 2004
Answered : 1725 Questions
User :   Suddenly one morning I started having vertigo in certain positions of head(on looking up, on going down to bed, changing position in bed). Doctor said that I am suffering from Cervical Spondylosis and asked me to do some exercises and heating therapy. I did that and after 2 weeks, vertigo was gone, but still I had vertigo sensation and heavy headedness in those position for a momentary seconds. Then for next 2 month nothing improved. I again went to Physician and my BP came out to be 145/98. He gave medication(Ciplar LA 1 BD) and I underwent BLood Tests, Urine tests, Ultrasounds as my age is 24 and doctor said there should be definitely a cause for hypertension. Later it was found that I had kidney infection(protein high) and have only one kidney by birth. Later with antibiotic, infection was gone and Blood Tests/Urine tests done after antibiotic duration came out normal. My Bp was measured and it came to 126/87. Doctor said single kidney is cause of hypertension in my case and he added Telma-40 1OD in addition to Ciplar LA BD. Then for next 2 weeks, Bp was under control and even reduced to 100/60. Sometimes it went down to 55 as well. I thought doctor would reduce the medication now but he didn't. So I went to another doctor and he gave me new med Amtas-5mg and old ones were put off. Then for next 2 days Bp was around 110/70-120/80. On third day suddenly BP shot upto 155/98 and I took some med at that point. Since then with Amtas-5mg, my BP remains 120/80-140/90. 140/90 when it becomes around 24rs since the last dose.
So effectively, I took Ciplar LA 1BD for 2 weeks, then Ciplar LA 1BD+Telma-40 1OD for 2 weeks and then Amtas-5mg for 1 week.


But the question that I wanted to ask was that after taking Amtas-5mg, my BP came down to 140/80 from 155/98 in just 15-20 mins. Even when it is 140/90, it came down to 123/80 in just 10-15 mins. Does it mean that Amtas-5
User :   acts immediately on BP to reduce it or its that after taking med, I feel relaxed and loss of anxiety brings the BP down cause I feel that all the meds/tablets takes atleast half an hour to start their action.
Doctor :   hi
Doctor :  
let me read what you have typed
User :   ok
Doctor :  
The BP medications work diffrently as they differ from class to class
User :   hmm
Doctor :   acting on different positions in the BP control cycle
User :   hmm
User :   But yesterday when my BP was 142/88, i took Amtas-5mg and even after 3 hours, my BP was still 136/84. Later I went to sleep and in the morning it was 126/82. Seems like Amtas-5mg virtually has no effect on me.
Doctor :  
since you have only 1 kidney, any infection or overload wil result in high BP
Doctor :  
you should drink plenty of water and continue 1 medication that gives adequate BP control
Doctor :  
and not keep changing medicines
User :   hmm
User :   so as of now should I continue with Amtas-5mg OD ?
Doctor :  
if the Ciplar is controlling BP in BD dose effectively
Doctor :  
i suggest that you continue the same
Doctor :   amtas reduces BP drastically at times
Doctor :  
so it is better that it s changed to alternate medications
Doctor :  
is there history of BP in family?
User :   no
Doctor :   ok

User :   i m the 1st
Doctor :  
what were the blood tests done for you?
Doctor :  
do you have the report with you now?
Doctor :  
if yes can you type the reports?
User :   but Amtas-5mg is not giving adequate control... BP remains from 120/80-140/90
User :   yeah
User :   I had serum complete lipid profile
User :   Urine 24 hr
Doctor :  
ok
User :   urine R/M
User :   Diabetes
Doctor :   can you type the results?
User :   ok
Doctor :  
it wil give me better idea of what was done and what values you got
User :   bt that will be a long list
User :   can i type only abnormal ones?
Doctor :  
ok
Doctor :  
then is scan is available, you can scan the reports and send at doctor@healthcaremagic.com
Doctor :  
ok you can type the abnormal ones
Doctor :  
the ones that have result outside the normal range value mantioned
User :   only Urine R/E was abnormal 1st time.. with Few epithelial cells and Proteins(2+/100mg/dl)
Doctor :  
ok
User :   doctor started Oflin fr 10 days
Doctor :  
ok
Doctor :  
tht is due to infection, it would hav egot better with the antibiotic
User :   after 10 days, Urine 24hr for protein was 0.12/24hr(
Doctor :  
ok
User :   and in Urine R/E on 2nd time
User :   all was normal
Doctor :  
could you tell me value of lipid profile ?
User :   yeah
Doctor :  
was anytime Renin levels, and cortisol levels checked?
User :   cholestrol was checked
User :   Renin and cortisol wasnt checked
Doctor :   what are the Serum Creatinine and Blood urea nitrogen test levels?
User :   Creatinine was 1.02mg/dl
User :   i am not able to find blood urea nitrogen
User :   is it in blood test?
Doctor :   its fine. no problem
Doctor :  
what did the ultrasound report suggest?
User :   Ultrasound and MRI said left kidney is normal
User :   everything is normal
User :   only compensatory hypertrophy is present
User :   right kidney is absent
Doctor :   ok

User :   my thyroid was also done and KFT too
Doctor :  
that is normal as it is single kidney, so some compensatory hypertrophy will be there
User :   and those were normal
Doctor :  
ok
User :   do i need to get renin and cortisol checked?
Doctor :  
for the cervical spine issue was MRI /CT scan done?
User :   yeah
User :   MRI was done
User :   it said cervical canal stenosis is visible with 9mm canal at C4-5,C5-6,C6-7
Doctor :  
yes it will show if the hypertension you have is due to their being high and leading to 'essential hypertension'
Doctor :  
ok
User :   what being high?
Doctor :  
so teh vertigo feeling will be due to the canal stenosis
User :   bt orthopedic doc says that this stenosis is to a very small extent
Doctor :  
renin and cortisol being high will lead to 'essential hypertension'
User :   and shouldnt cause vertigo
User :   and i am doing cervical exercises since 2 mnths and nothing improved
Doctor :  
stenosis and disc bulge even if small wil result in diffrent people responding differently to them
Doctor :  
spinal canal stenosis cannot be reverted back with exercises
User :   yeah, bt it will help in realignment
User :   and reduce pressure on root nerves
User :   i guess
Doctor :  
the disc bulge if present needs tp be managed, it will giv ereleif with SWD and other physiotherapy modules
Doctor :  
which will help the relaxation of the cervical vertebral joints
Doctor :  
thereby releasing pressure on it
User :   yeah, i got SWD for 15 days and physiotherapy exercises fr 2 mnths
User :   and traction fr 10 days
Doctor :  
and the nerveroots will feel free
Doctor :  
resulting in relief from symptoms
User :   1 week back neuro doctor said that i have position vertigo
Doctor :  
but is it not a permanent cure, it will give temporary relief
Doctor :  
ok
User :   and ENT doc said i hav some problem in my right ear as audiometry revealed some mild hearing loss in right ear
Doctor :  
ok
Doctor :  
the ENT issue wil be completely different from spinal issue
User :   yeah
Doctor :  
do not get confused with both
Doctor :  
as per the history and discussion what we had so far
User :   but doc said that it can cause positional vertigo if infection is present in inner ear
Doctor :  
I could reach to these probable possibilities
User :   yeah?
Doctor :  
1) positional vertigo due to ear infection. which needs to be further evaluated if inner ear is really infected or if there is fluid imbalance in inner ear
User :   btw, while standing or sitting, if i rotate head to left or right nothing happens
User :   but while lying down, i feel vertigo sensation on rotating head left or to right side while lying on my back
Doctor :  
2) cervical canal stenosis, and disc bulge wil need further management symptomatically with physiotherapy, and osteophyte if present or disc bulge if present severely, wil need decompression surgery
User :   yeah, thats what orthopedic doc said that disc bulge is to a very small extent.. and there is a very small anterior osteophyte and these most probably shudnt cause vertigo sensation
Doctor :  
3) the hypertension and single kidney issue, to be evaluated further will require the testing on a) renin-angiotensin system, b) renal artery stenosis, c) other space occcupying lesions in kidney
Doctor :  
the vertigo that you are having , and the way you just described it to me
User :   renal artery stenosis and lessions is kidney are done
User :   in kidney ultrasound and kidney MRI
Doctor :  
suggests that the inner era is not that much a problem
User :   and all was normal
Doctor :  
but the osteophyte and disc bulge coul dbe related
Doctor :  
since there is infection detected in right ear and a abnormal audiometry
Doctor :  
the effect that you are having
Doctor :  
of vertigo is more pronounced
User :   i am not having vertigo
Doctor :  
and it wil need to be tackled with multidiscliplinary approach
User :   its vertigo kind sensation
Doctor :  
combining ENT, ORTHO, and Nephro departments
Doctor :  
ok
User :   its like when i rotate, my head feels heavy and i feel like having a vertigo but before it stops immediately
Doctor :  
ok
User :   so in effect i dont have any shift/spinning
User :   but it feels like vertigo
Doctor :  
doe sthis happen more often when BP is not controlled?
User :   it happens always
Doctor :  
ok
User :   on those positions
User :   and for BP, should I go back to Ciplar LA 1BD+ Telma-40 OD
User :   or stay with Amtas-5mg 1OD
Doctor :  
are you doing the exercises suggested for vertigo?
User :   i havnt started exercises fr positional vertigo yet completely
User :   just few ones of looking up in neck extension, and looking sideways
Doctor :  
for the BP control, themedication to be taken should be decided based on 1) the BP control duration and quality
Doctor :  
2) the type of BP control expected
Doctor :  
ok
User :   doctor says my bp should be 110/70
Doctor :  
so for vertigo, start with other exercises to help you better with vertigo
Doctor :  
and for Bp control
User :   and with amtas its always 120+/80+ and many times its 130+/80+ and sometimes its 140/90
Doctor :  
see which combination of drugs gives adequate control over 24 hours
Doctor :  
ok
Doctor :  
then in that case I would not advise amtas for you
User :   with Ciplar LA + Telma it was 110/70 mostly, 100/60 sometimes
Doctor :  
is the BP properly or relatively better controlled with Ciplar LA + Telma?
User :   doc says i can take Amtas-5mg twice, but amtas virtually doesnt have any effect on me
Doctor :  
ok, then Ciplar LA + Telma is giving you better BP control as needed for your age
User :   and i think taking it twice wont help as well
User :   so I can immediately go back to Ciplar LA + Telma?
User :   will that cause any problem?
Doctor :  
so continue with Ciplar LA + Telma, meet another doctor, and get the prescription changed after explaining the scenario to him/her
Doctor :  
and go for regular BP checks BD for a week or 2
User :   i have machine at home
Doctor :  
to see that whether Ciplar LA + Telma is acting well
User :   and I check my Bp 4/5 times in a day
Doctor :  
to keep BP in desired elvels
Doctor :  
both ion morning and eveving
Doctor :  
ok, thats good.
Doctor :  
then you can maintain a BP time diary/note
Doctor :  
mentioning BP readings for over the whole day for a week
Doctor :  
and show it to doctor
User :   bt still i dont get why my BP is high suddenly after changing medicine
Doctor :  
while being on Amtas, and then while being on Ciplar LA + Telma
User :   I got all the blood tests/urine tests done 1.5 weeks back
User :   do i need to get them dome again to figure out if something has come up?
Doctor :  
the body needs time to adjust to change of medicine, and it is not good to keep changing i=them often
Doctor :  
no you wont need to do the tests that are already done
Doctor :  
have you followed?
User :   1.5 weeks back my bp was good with Ciplar + Telma
User :   yeah.
Doctor :  
then it should have been continued?
User :   so i should continue with Amtas-5mg for a week
Doctor :  
why was the medicine changed?
User :   i went to a different doc and he though my bp is in control and he reduced the medicine
User :   Ciplar LA + Telma is quite heavier than Amtas once in a day i guess
Doctor :  
if you are on Amtas right now, maintain a BP cahrt as I suggested and show to your doctor the diffrent fluctuations noted with Amtas
Doctor :  
ad request to be put back on Ciplar+Telma
Doctor :  
is there anything else i can help you with?
User :   hmm
User :   so for being on amtas for one week,
User :   i wont hurt to have 140/90 bp for a week?
Doctor :  
if the BP remains at this level for more than 2 days
Doctor :  
then a week wait is not advised
User :   yeah its more than 3 days now
Doctor :  
but should report to doctor immediately and be back on the medications that give adequate control
User :   i did that
User :   and he said take amtas twice
User :   bt that wont help
Doctor :  
hav eyou taken Amtas BD?
User :   nope
Doctor :  
does that control BP?
User :   when i take amtas.. even after 4-5 hrs.. bp is still 130+/80+
User :   so taking twice wont help probably
User :   thats why i want to go back to Ciplar LA + Telma
User :   and want to know is it safe to go back to it or not?
Doctor :  
do not assume the effect of the medication. If it has been advised to take BD, then first see if the sugested doses work for you
Doctor :  
and taking Amtas Bd, stil you are on only 1 drug
Doctor :  
which means less load on your kidney to excrete it
User :   and its less heavier than Ciplar LA 1BD+Telma-40 OD?
Doctor :  
rather than excreting 2 drygs
Doctor :  
*drugs
Doctor :  
so with this in mind that you have a single kidney, your doctor would hav esuggested you to be on 1 drug
User :   hmm
User :   so my bp should be 110/70 all the time to be said to have good control?
Doctor :   yes
User :   hmm
Doctor :  
diastolic BP can be upto 80mmHg
User :   with amtas, even after taking med its not that much
User :   i mean its not under 120/80
Doctor :  
then this has to be report as I suggested earlier
User :   i mean relative to time of taking it
User :   hmm
Doctor :  
and request your doctor to put you back on the combination of Ciplar and Telma
Doctor :  
to get that control
User :   hmm
Doctor :  
is there anything else you would like to ask me?
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