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Avatar universal

blood pressure medication post liver transplant

Hello Dr.
Blood pressure had been well controlled in the past with Norvasc 10mg 1x daily and Metroprolol 25mg 2x daily. However, most recently, experiencing high blood pressure since the Nephrologist switched the Norvasc to Lorsartan 100mg 1x daily. Readings have been in the mid 160's even in the 170's. In addition, the Metroprolol was discontinued (it wasn't really helping the heart palpations) and have been prescribed Atenolol 25mg 1x daily for the heart palpitations. Now, Dr is adding Nifedipine 30mg 1x daily to try and lower blood pressure. Is it okay to take Atenolol 25 mg 1x daily, Lorsartan 100mg and the Nifedpine 30mgs? Isnt that a lot of "different types" of medications especially being recently (less than 1 year) post transplant? Is this safe? I do however need to have the high blood pressure addressed. Advice/help. Thank you in advance.
12 Responses
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517301 tn?1229797785
MEDICAL PROFESSIONAL
thanks.  good luck
Helpful - 0
Avatar universal
Spoke with the Nephrologist...doesn't seem to think that it is Renal Artery Stenosis. The cardiologist and nephrologist might increase the Norvasc to 10mg if the blood pressure continues to remain elevated. Fingers crossed that the HTN will get under control soon. Thank you very much for ALWAYS answering my questions.
Helpful - 0
517301 tn?1229797785
MEDICAL PROFESSIONAL
prograf definitely causes high blood pressure.  a renal ultrasound will diagnose renal artery stenosis, which could make HTN refractory to medications. Losartan is a good medication; you may need more of it and/or additional medications
Helpful - 0
Avatar universal
The blood pressure was very well controlled (120's low 130's) when taking the original medication of just Norvasc 10mg. Once discontinuing the Norvasc and starting the Lorsartan 100mg, that's when the BP reading became elevated in the 160's to 180's range.
1. Is it possible that the Lorsartan is not a great medication (in this particular case) to help with the HTN?
2. If this truly is renal artery stenosis, wouldn't the past medication, Norvasc have been unsuccessful in treating the HTN?
3. Should I ask Nephrologist to do an ultrasound of Kidneys?
4. Does prograf cause high blood pressure? Could this be one of the reasons for HTN?
Thank you.
Helpful - 0
517301 tn?1229797785
MEDICAL PROFESSIONAL
the transplant team can adjust the medications but I have often found that a nephrologist or cardiologist will be more tuned into this.  Either of these docs can diagnose renal artery stenosis, which can be diagnosed with a doppler ultrasound
Helpful - 0
Avatar universal
The HTN really seems to be stubborn. Wouldn't the Nephrologist be aware if renal artery stenosis is causing the HTN? What tests are able to determine if there is renal artery stenosis? Is it via blood test or CT scan/ultrasound? Which medication would you consider increasing? In regards to the prograf, currently taking 2.5mg 2x daily. Almost one year post transplant. Very worried.

*** I also wanted to add, if the transplant meds may be contributing to the HTN, should I have the nephrologist or the cardiologist, reach out to tge transplant team? Also, my concern is, the Lorsartsan 100mgs, isn't that already a "high dosage"? HP was good in the last month on Norvasc 10mgs (along w the Metroprol 25mgs 2x daily)...I understand that the Lorsartan also helps the kidneys but since the switch theses BP readings are extremely high. What should I do? As always, thank you for answering my questions.
Helpful - 0
Avatar universal
The HTN really seems to be stubborn. Wouldn't the Nephrologist be aware if renal artery stenosis is causing the HTN? What tests are able to determine if there is renal artery stenosis? Is it via blood test or CT scan/ultrasound? Which medication would you consider increasing? In regards to the prograf, currently taking 2.5mg 2x daily. Almost one year post transplant. Very worried. As always, thank you for answering my questions.
Helpful - 0
517301 tn?1229797785
MEDICAL PROFESSIONAL
the HTN is not bad for the liver but its bad for the hear and kidneys.  i think all of the medications need to be increased further and maybe the prograf dose can be decreased somewhat.  if the HTN is refractory then the docs may also need to look for secondary causes such as renal artery stenosis.
Helpful - 0
Avatar universal
It was decided to add Norvasc 5mg INSTEAD of Nifedipine, since Norvasc was used/tolerated well in the past. Began taking Norvasc 5mg along with Lorsartan 100mg and Atenolol 25mg (all 1x daily) approximately 3 days ago, and the  blood pressure is still running extremely high. This morning reading was 186/85 and tonight 176/110!!! Worried that this can be dangerous. What should be done? How long until the BP goes to a "normal" range? Does the doctor need to increase the Norvasc dosage? If yes, when?
As mentioned originally, was taking Norvasc 10mg 1x daily along w Metrprolol 25mg 2x daily and blood pressure reading were perfect/normal. All this HTN began as soon as the Norvasc and Metroprolol were discontinued and the Lorsartan 100mg and Atenolol 25mg were begun...now to only have the Norvasc added back but at 5mg versus 10mg!
Can the HTN be dangerous for the new liver? Very worried. Thank you!
Helpful - 0
517301 tn?1229797785
MEDICAL PROFESSIONAL
HTN is hypertension.  The transplant meds can cause HTN.  Either a cardiologist or nephrologist would be fine to help manage your HTN.
Helpful - 0
Avatar universal
Yes...post transplant (10 months post). Which Dr (cardiologist or nephrologist) should I make sure, is taking the lead on this? Does transplant cause high blood pressure? What does HTN mean???
Helpful - 0
517301 tn?1229797785
MEDICAL PROFESSIONAL
its OK to take these 3 different antihypertensives (I assume post-transplantation).  I would make sure there is either a cardiologist or nephrologist involved as the management of the HTN can be quite complicated and is extremely important
Helpful - 0

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