Hello doctor, I am a 57-year-old male with polycystic kidney disease. My BMI is 27, and I am a non-smoker. My creatine ~1.25, eGFR ~63. I am currently on 30 mg Lisinopril, 12.5 mg Hydrochlorothiazide daily. Most recently I changed to (6 months ago), taking 40 mg Lisinopril only and noticed bp increasing so added the HCT. Since starting HCT, hypernatremic @ NA=130. My query is I get a rapid spike in blood pressure over the course of two to three days from well-controlled 130/80 mmHg to 165/105 mmHg which has maintained for the last seven days and continues. What are the possible causes of such a rapid sustained spike?
Hello. The causes of this accelerated phase could be multiple. Is there any change in dietary habit with increased salt intake? Any recent change in antihypertensive? Did you by any chance miss antihypertensive medications? Any consumption of pain killer NSAIDs (nonsteroidal anti-inflammatory drugs)? If none of this is true sometimes it could be just because of variation in weather with winters starting. My advice will be to continue with Lisinopril as advised. As HCTZ (hydrochlorothiazide) is causing hyponatremia I will stop that and can add Tolvaptan which has been approved specially for ADPKD (autosomal dominant polycystic kidney disease). This has to be done by your nephrologist though. For better control of BP add Amlodipine 5 mg once daily and monitor blood pressure. Please note that a common cause of hyponatremia in such a scenario is increased water intake, salt restriction, reduced protein intake and hydrochlorothiazide. Combination of these factors is common in ADPKD patients as doctors would be advising for all these.