Managing Blood Pressure Fluctuations: Concerns and Solutions for Kidney Health

Blood pressure issues?

I currently take one Norvasc tablet for blood pressure every morning.
My blood pressure readings at home in the morning and evening consistently range from 112-120 mmHg systolic and 69-78 mmHg diastolic.
However, every time I measure my blood pressure outside, it tends to be around 140/90 mmHg, which is almost always above the normal range.
I'm concerned whether this fluctuating blood pressure could harm my kidneys.

Previously, when I weighed 88 kg at a height of 176 cm, I was taking two tablets daily, and my blood pressure readings at the hospital or outside were normal, around 110/70 mmHg.
Over the past year, I have controlled my diet and gradually lost 20 kg.
I noticed that taking two tablets now causes my blood pressure to drop too low, making me feel dizzy, so my doctor reduced my medication to one tablet per day.
However, after switching to one tablet, my blood pressure readings at the hospital have been high, while those at home remain normal.
The doctor at the clinic advised that the home readings should be considered more reliable.
Despite this, my consistently high blood pressure readings outside worry me about potential kidney damage or stroke.
Occasionally, I still experience dizziness while taking one tablet.
The doctor reviewed my home blood pressure data over a month and suggested I could reduce my medication to half a tablet, but I'm concerned that this might lead to high blood pressure readings at the hospital or outside.
I believe my anxiety might also contribute to this issue.
Are there any anti-anxiety medications that could help improve my situation? If I lose another 5-10 kg, could I potentially stop taking medication? I've also heard that long-term use of blood pressure medications may increase the risk of cancer.

Youo, 40~49 year old female. Ask Date: 2023/04/09

Dr. Wu Xueming reply Cardiology

The long-term goal for blood pressure control is to maintain it below 130/80 mmHg.
If this can be achieved through exercise and dietary modifications, medication may not be necessary.

Reply Date: 2023/04/09

More Info

Managing blood pressure fluctuations, especially in relation to kidney health, is a complex issue that requires a comprehensive understanding of both physiological and psychological factors. Your situation, characterized by significant variations in blood pressure readings between home and clinical settings, is not uncommon and can be influenced by several factors, including anxiety, lifestyle changes, and medication adjustments.

Understanding Blood Pressure Variability
Blood pressure can fluctuate due to various reasons, including stress, physical activity, and even the environment in which it is measured. The phenomenon you are experiencing, where your home readings are significantly lower than those taken in a clinical setting, is often referred to as "white coat syndrome." This condition occurs when patients exhibit elevated blood pressure in a medical environment due to anxiety or stress, while their readings at home are normal.

Impact on Kidney Health
Regarding your concern about whether these fluctuations can harm your kidneys, it is essential to understand that consistently high blood pressure (hypertension) can lead to kidney damage over time. The kidneys are highly vascular organs, and prolonged hypertension can cause damage to the blood vessels within the kidneys, leading to chronic kidney disease (CKD). However, if your home readings are consistently within the normal range, it is less likely that your kidneys are being adversely affected at this time.

Medication Management
You mentioned that you are currently taking one pill of Amlodipine (耐比諾) daily and have experienced dizziness when taking higher doses. It is crucial to work closely with your healthcare provider to find the right balance in your medication regimen. If your doctor has suggested reducing your dosage based on your home readings, it is likely they are considering the overall picture of your health, including your weight loss and lifestyle changes.

Lifestyle Modifications
Your weight loss of 20 kg is a significant achievement and can positively impact your blood pressure and overall health. Continued efforts to maintain a healthy diet, engage in regular physical activity, and manage stress can further improve your blood pressure control. Reducing sodium intake, increasing potassium-rich foods (like bananas and spinach), and incorporating more fruits and vegetables into your diet can also be beneficial.

Anxiety and Blood Pressure
Your anxiety about blood pressure readings can create a feedback loop, where stress leads to elevated blood pressure, which in turn increases anxiety. This cycle can be addressed through various methods, including mindfulness practices, cognitive-behavioral therapy (CBT), or relaxation techniques. If anxiety significantly affects your daily life, discussing the possibility of anti-anxiety medications with your healthcare provider may be beneficial.

Future Considerations
As for the possibility of stopping your medication after further weight loss, this is a conversation best had with your healthcare provider. They can assess your overall health, including kidney function and blood pressure trends, to determine if medication can be safely discontinued.

Cancer Risk and Long-term Medication Use
Concerns about long-term medication use and potential cancer risks are valid but should be discussed with your healthcare provider. The benefits of controlling hypertension often outweigh the risks associated with long-term medication use, especially when considering the potential complications of uncontrolled high blood pressure, such as heart disease and stroke.

Conclusion
In summary, managing blood pressure fluctuations requires a multifaceted approach that includes medication management, lifestyle changes, and addressing psychological factors. Regular follow-ups with your healthcare provider are essential to monitor your progress and make necessary adjustments to your treatment plan. By maintaining a healthy lifestyle and managing stress, you can significantly improve your blood pressure control and overall health, thereby reducing the risk of kidney damage and other complications.

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