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Have high BP, taking Telma, stopped medication due to potassium content, now taking Amplopiphine. Suggest better option

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General & Family Physician
Practicing since : 1978
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my mother is suffering from high BP problem. Before she was taking telmaAM 40 for 1 month but didnt control BP and also stopped because of potassium content of medicine. Now last one week she started taking Amplopiphine 10 and telma 20mg separately but from last one week BP is going high everyday by 10. Plz suggest a better option.
What to do next. She is suffering from CKD kidney prob and its very important to have her BP under control
Posted Sat, 21 Jul 2012 in Hypertension and Heart Disease
Answered by Dr. Pavan Kumar Gupta 45 minutes later
Thanks for the query. 
All types of blood pressure medications are shown to be effective in lowering blood pressure in CKD. However it often takes more than one to do the job. According to the Clinical Practice Guidelines on Hypertension and Antihypertensive Agents in Chronic Kidney Disease, issued by the National Kidney Foundation in 2005, if you have kidney disease, your target blood pressure should be below 130/80 mm Hg. 
The use of antihypertensive agents in patients with renal insufficiency necessitates careful consideration of dosages, titration, and monitoring.
 Renal function must be estimated to appropriately make dosage adjustments for antihypertensives that exhibit extensive renal elimination. Thiazide diuretics are useful in mild degrees of renal insufficiency but loop diuretics become necessary as renal function deteriorates further. With either class, low dosages should be used to prevent hypovolemia, hyponatremia, and hypokalemia which may worsen renal blood flow.
 Angiotensin-converting enzyme (ACE) inhibitors and ARB's have become popular because they may have unique renal protective properties. All ACE inhibitors except fosinopril require reduced dosages and/or less frequent administration in patients with renal insufficiency. It is often necessary to use a diuretic with an ACE inhibitor and special dosing considerations are important. Due to demographic and physiologic characteristics of patients with renal insufficiency, beta blockers are often reserved for patients with other indications for beta blockers such as ischemic heart disease. Several beta blockers are eliminated primarily by the kidney and dosage reductions are necessary for these agents. Calcium antagonists may also have renal protective effects. Because calcium antagonists are metabolized extensively, significant dosage adjustments are not necessary. Data suggest that antihypertensives may slow the decline in renal insufficiency. The pharmacokinetics of several antihypertensives change with renal impairment because of reduced elimination. Therefore, dosage adjustments, slower titration, and less frequent administration are often necessary.

Since treating HYPERTENSION in CKD is a complex issue,you must consult your nephrologist and a cardiologist for the proper assessment of the patient,treatment and regular monitoring of the patient.
Online doctors like us have our limitations and we can't advise any treatment.
Our goal is to explain and educate you.
I hope I am clear however you may revert to me for any other query.
Best of luck.
Above answer was peer-reviewed by
Follow-up: Have high BP, taking Telma, stopped medication due to potassium content, now taking Amplopiphine. Suggest better option 14 hours later
Thanks for your reply.

We have already consulted a nephrologist.

But my question to you in about Blood pressure. As i already mentioned My mother is taking Amplopehine 10 mg and telma 20 mg from last one week as suggested by nephrologists., but after continuous monitor from last one week its noticed her BP is going up everyday by day and yesteday gone upto 160/90. So plz suggest medicine. She is already reduced salt and following renal diet.

I want a suggesstion about Blood Pressure medicine. either to change or increase content of telma?

Answered by Dr. Pavan Kumar Gupta 2 hours later
It will not be prudent on my part to prescribe the medicine to you.
It is the prerogative of your treating doctor to increase or decrease the dose or add any medicine.
I hope you understand this.
You are welcome to pose any query to me.
Above answer was peer-reviewed by
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