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Medical Forum / General / Cardiology / June 2009Target BP?
My old cardiologist used to joke that your BP was not low enough until you could not stand up. Seriously, how low is low enough, and how low is too low? At what point is low blood pressure actually harmful? At what point do you risk kidney damage from low blood pressure? I have noticed if you keep it pretty low, urine output decreases even on diuretics. Is this decrease an indication damage is being done or is it a normal response where the renal system is trying to build vascular volume? Syd wrote: >My old cardiologist used to joke that your BP was not low enough until you could >not stand up. Seriously, how low is low enough, and how low is too low? As low as tolerable. Too low would be when symptoms are intolerable. > Atwhat point is low blood pressure actually harmful? When symptoms are intolerable. > At what point do you risk kidney damage from low blood pressure? Loss of consciousness. > I have noticed if you keep it pretty >low, urine output decreases even on diuretics. Is this decrease an indication >damage is being done or is it a normal response where the renal system is trying >to build vascular volume? It is the expected response by the kidneys to slow the loss of intravascular volume. Be hungrier, which is truly healthier for mind, body, and soul: http://groups.google.com/group/sci.med.cardiology/msg/991d4e30704307e7? Marana tha Prayerfully in the awesome name of our Messiah, LORD Jesus Christ, Andrew <>< -- Author of WDJW: http://en.wikipedia.org/wiki/What_does_Jesus_want%3F "... no one can say 'Jesus is LORD' except by the Holy Spirit." (1 Cor 12:3) http://groups.google.com/group/sci.med.cardiology/msg/035c93540862751c? What are the keys of the Kingdom of Heaven? http://groups.google.com/group/sci.med.cardiology/msg/980b41e6999de315? Only the truth can cure the "hunger is starvation" delusion: http://groups.google.com/group/sci.med.cardiology/msg/74281ab7d7ce78de? >> At what point do you risk kidney damage from low blood pressure? > >Loss of consciousness. Then how could low blood pressure be the mechanism by which my kidneys went into failure? I thought you said low BP could damage the nephrons. Discontinuation of Metformin, HCTZ, and an ACE Inhibitor brought the kidneys back from the brink. What then is the likely mechanism of damage and recovery? > On Fri, 19 Jun 2009 05:42:25 -0400, "Andrew B. Chung, MD/PhD" > <achung@emory.edu> [quoted text clipped - 10 lines] > of Metformin, HCTZ, and an ACE Inhibitor brought the kidneys back from the > brink. What then is the likely mechanism of damage and recovery? Are you kidding me??? You're asking Chung for medical advice? Nice knowing you... > <ana...@logwell.com> wrote in message > [quoted text clipped - 17 lines] > Are you kidding me??? You're asking Chung for medical advice? Nice knowing > you... SIT! Syd wrote: > Andrew, in the Holy Spirit, boldly wrote: > [quoted text clipped - 4 lines] > Then how could low blood pressure be the mechanism by which my kidneys went into > failure? ACE inhibitors make the kidneys more vulnerable to low blood pressure (hypotension). This is why they are typically held pre-operatively. > I thought you said low BP could damage the nephrons. See above. > Discontinuation >of Metformin, HCTZ, and an ACE Inhibitor brought the kidneys back from the >brink. What then is the likely mechanism of damage and recovery? http://www.aafp.org/afp/20000401/2077.html Be hungrier, which is truly healthier for the heartl: http://TheWellnessFoundation.com/BeHealthier Marana tha Prayerfully in the awesome name of our Messiah, LORD Jesus Christ, Andrew <>< -- Author of WDJW: http://en.wikipedia.org/wiki/What_does_Jesus_want%3F "... no one can say 'Jesus is LORD' except by the Holy Spirit." (1 Cor 12:3) http://groups.google.com/group/sci.med.cardiology/msg/035c93540862751c? What are the keys of the Kingdom of Heaven? http://groups.google.com/group/sci.med.cardiology/msg/980b41e6999de315? Only the truth can cure the "hunger is starvation" delusion: http://groups.google.com/group/sci.med.cardiology/msg/74281ab7d7ce78de? >> Then how could low blood pressure be the mechanism by which my kidneys went into >> failure? > >ACE inhibitors make the kidneys more vulnerable to low blood pressure >(hypotension). This is why they are typically held pre-operatively. Interesting, yet many diabetics are on ACE Inhibitors to protect the kidneys. Are there any guidelines that flow from all this contradictory reality? Syd wrote: > Andrew, in the Holy Spirit, boldy wrote: >> Syd wrote: [quoted text clipped - 6 lines] >> >Interesting, yet many diabetics are on ACE Inhibitors to protect the kidneys. ACE inhibitors effectively do this by reducing pressure at the level of the glomerulus of the kidney nephron. >Are there any guidelines that flow from all this contradictory reality? Long term benefit of kidney protection of ACE inhibitors for diabetics outweigh the transient risk of kidney failure in the setting of hypotension especially when they are held pre-operatively. Be hungrier, which is truly healthier for mind, body, and soul: http://TheWellnessFoundation.com/BeHealthier Love in the truth, Andrew <>< -- Andrew B. Chung, MD/PhD Board-certified Cardiologist Author of WDJW: http://en.wikipedia.org/wiki/What_does_Jesus_want%3F http://groups.google.com/group/sci.med.cardiology/msg/9642aafa0aad16eb? Only the truth can cure the "hunger is starvation" delusion: http://groups.google.com/group/sci.med.cardiology/msg/74281ab7d7ce78de? >ACE inhibitors effectively do this by reducing pressure at the level >of the glomerulus of the kidney nephron. [quoted text clipped - 4 lines] >outweigh the transient risk of kidney failure in the setting of >hypotension especially when they are held pre-operatively. OK. So what about the patient who is achieving pretty low BP with diuretics and a beta blocker, etc.? Is an ACE inhibitor contraindicated below a certain BP? I am having a hard time understanding the practical use of the typical CHF cocktail. It would seem there is too muck risk of kidney damage if an ACE inhibitor is used and good BP control is achieved with the other drugs. Syd wrote: > Andrew, in the Holy Spirit, boldly wrote: >>Syd wrote: [quoted text clipped - 10 lines] >OK. So what about the patient who is achieving pretty low BP with diuretics and >a beta blocker, etc.? Is an ACE inhibitor contraindicated below a certain BP? Generally, ACE inhibitors are not started in folks with normal blood pressure. >I am having a hard time understanding the practical use of the typical CHF >cocktail. It would seem there is too muck risk of kidney damage if an ACE >inhibitor is used and good BP control is achieved with the other drugs. Generally, in this setting, an exchange is made where the other anti-hypertensive medications are lowered to accommodate the addition of an ACE inhibitor. Be hungrier, which is truly healthier for mind, body, and soul: http://HeartMDPhD.com/BeSmart Love in the truth, Andrew <>< -- Andrew B. Chung, MD/PhD Board-certified Cardiologist and Author of "Be Hungry" http://NetCabal.com "Don't be left behind as were Cleopas and Simon ... ... -----------------> be hungry ! ! !" http://groups.google.com/group/sci.med.cardiology/msg/9642aafa0aad16eb? Only the truth can cure the "hunger is starvation" delusion: http://groups.google.com/group/sci.med.cardiology/msg/74281ab7d7ce78de? |
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