Hitgh Blood Pressure on Tx

[BklynBoy81]

Whats up guys!! I'm 6 weeks into Tx now.. I'm still feeling pretty good.. No exteme Sx so far... I'm in the Telaprevir trial and i go to the study nurse almost every week to get the blood test and to get a quick physical.. well every time i go my blood pressure is threw the roof... 148/102 I went to my regular doc and she gave me a script for blood pressure meds... Do you think the Hep C Meds are causeing my high blood pressure???

i'm already taking 12 pills aday for the hep c, now i gotta take more pills.. Great
I know high blood pressure is a serious thing and i wanna know if i can get away with out taking the pressure meds??
Is there a different way to fix my blood pressure without taking the meds??? or should i shut up and just take the pills?? lol

I did have little problems before tx with blood pressure but it turn out that i was just extremely **** off about having Hep c... so when i relaxed alittle my blood pressure would go to normal...

If nobody knows i am UND at 2 weeks into Tx.. I'm responding well :0)

[jmjm530]

BTW, being a grouch is associated with IR....so is elbow pain, I believe.
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How about being dillusional. LOL.

[CoWriter]

Isn't it interesting how the HOMA-IR and insulin level was progressively elevated along with the severity of hepatic fibrosis?  you know what that means?  Cirrhotics are IR.

BTW, being a grouch is associated with IR....so is elbow pain, I believe.

LOL

Co

[jmjm530]

Interesting on the ARB study and the liver. I had read similar before I took Cozaar but unfort didn't help my bp much is why I may try an Ace Inhibitor next.

[jmjm530]

Why are you posting this to me :) This has nothing to do with the previous discussion about BB, his RVR and his high BP. As to the study you posted, this is nothing new nor do I disagree with the premise that IR is detrimental to SVR. We do not have a disagreement regarding IR and SVR, just perhaps when and how to intervene.

-- Jim

[CoWriter]

New study.....

Insulin resistance is a MAJOR determinant of sustained virological response in genotype 1 chronic hepatitis C patients receiving peginterferon alpha-2b plus ribavirin.

Chu CJ, Lee SD, Hung TH, Lin HC, Hwang SJ, Lee FY, Lu RH, Yu MI, Chang CY, Yang PL, Lee CY, Chang FY.
Division of Gastroenterology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.

Background Cross-sectional studies suggest insulin resistance is strongly associated with hepatic steatosis and fibrosis in patients with chronic hepatitis C (CHC), which might affect the efficacy of antiviral therapy. Aim To investigate retrospectively the impact of insulin resistance on treatment response in Chinese genotype 1 CHC patients receiving a 24-week course therapy with peginterferon alpha-2b/ribavirin. Methods A total of 133 biopsy-proven CHC patients were enrolled for analyses. Insulin resistance was evaluated by homeostasis model assessment of insulin resistance (HOMA-IR). Hepatic fibrosis was graded by the METAVIR scoring system. Results Mean HOMA-IR progressively elevated along with the severity of hepatic fibrosis (F1-F2 fibrosis: 2.55 +/- 0.16 vs. F3-F4 fibrosis: 3.61 +/- 0.20, P < 0.001). Compared with patients with sustained virological response (SVR), patients without SVR had significantly higher percentages of F3-F4 fibrosis (62.2% vs. 21.6%, P /=600 000 IU/mL; 64.4% vs. 35.6%, P = 0.038). In addition, patients without SVR had significantly higher plasma levels of insulin (15.03 +/- 0.89 vs. 10.19 +/- 0.55 muU/mL, P < 0.001) and HOMA-IR values (3.76 +/- 0.23 vs. 2.50 +/- 0.15, P < 0.001). Multivariate analyses showed that F1-F2 fibrosis (odds ratio: 4.49, P = 0.001), HOMA-IR < 2 (odds ratio: 7.15, P = 0.005) and pre-treatment hepatitis C virus RNA < 600 000 IU/mL (odds ratio: 3.26, P = 0.012) were the independent factors associated with SVR. Conclusions Insulin resistance is a major determinant of SVR in genotype 1 CHC patients receiving peginterferon alpha-2b/ribavirin. Strategies to modify insulin resistance may be effective in enhancing SVR before or during anti-viral therapy.


http://www.ncbi.nlm.nih.gov/pubmed/18680550?ordinalpos=43&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

[CoWriter]

Int J Mol Med. 2008 Oct;22(4):521-7.

Therapeutic effect of ARBs on insulin resistance and liver injury in patients with NAFLD and chronic hepatitis C: a pilot study.

Enjoji M, Kotoh K, Kato M, Higuchi N, Kohjima M, Nakashima M, Nakamuta M.
Department of Clinical Pharmacology, Fukuoka University, Fukuoka 814-0180, Japan.

Fatty liver is one of the local morphological manifestations of metabolic syndrome and is frequently associated with insulin resistance. Insulin resistance is also common in patients with chronic hepatitis C. Hyperinsulinemia is an independent risk factor for hypertension and cardiovascular mortality. The aim of this study was to evaluate the therapeutic efficacy of angiotensin II receptor blockers (ARBs), telmisartan and olmesartan, for patients with non-alcoholic fatty liver disease (NAFLD) and chronic hepatitis C (CH-C). We analyzed the incidence of obesity, insulin resistance, and other disorders in patients with NAFLD (Group A), CH-C (Group B), or other liver diseases (Group C). We evaluated whether the ARBs, telmisartan and olmesartan, improved insulin resistance and liver injury by measuring the homeostasis model assessment ratio of insulin resistance (HOMA-IR) and serum alanine aminotransferase (ALT). The incidence of obesity (BMI > or =25 kg/m2) was significantly higher in Group A than in Groups B and C. The incidence of insulin resistance (HOMA-IR > or =2.5) in Groups A and B was significantly higher than in Group C. Regular doses of telmisartan and olmesartan significantly improved HOMA-IR and ALT levels not only in NAFLD patients but also in patients with CH-C. The effects tended to be more notable with telmisartan. In conclusion, telmisartan and olmesartan improved insulin sensitivity and may possibly be used as liver protecting agents in CH-C as well as NAFLD patients.

http://www.ncbi.nlm.nih.gov/pubmed/18813860?ordinalpos=33&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

[CoWriter]

The first thing is not to let your blood pressure get high again by stressing.  The bp med doesn't need to be changed immediately.  You can take this one until you see your doctor again.  

And find out what your fasting blood sugar was and let me know.  Just so I can beat Jim in this discussion.

Co

[portann]

http://general-medicine.jwatch.org/cgi/content/full/2008/1229/8

[portann]

You're doing great so far.

You should continue on the atenolol for the time being, according to your rx.

If you can print out Co's list, though, you can bring it along to the nurse at your next visit and ask her if she can get an answer from the trial doc.

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from Co:

I would ask the doctor to change it.  If he asks why, I would say.....

1.  Because I have a family history of diabetes and beta blockers are known to cause diabetes.
2.  Because interferon can cause insulin resistance/diabetes.
3.  Because PI's can cause insulin resistance.
4.  Because insulin resistance and diabetes can lower SVR greatly.
5.  Because there are better options.

Co

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Meanwhile, don't let it knock you off balance.

[jmjm530]

This is an interesting thread with lots of information but personally I wouldn't stress yourself out. Fact is that your UND at week 2 which bodes very well for SVR. That is a fact. If you still have concerns about your familial IR issues, why don't you ask to speak to your doc and run it by him, or minimally have your NP run it by the doc who I assume is a hepatologist. If they say go ahead with the bp meds, then that is what I would do and not drive yourself crazy. Alternatively, you could suggest an alternative bp med such as an Ace Inhibitor and see what they say. Honestly, either way I don't think you should worry, so far you're doing excellent.

-- Jim

[BklynBoy81]

doesn't the liver store sugar... every time i tested my blood sugar was in the morning... as soon as i woke up...

[BklynBoy81]

i dont think the doctors at the hosiptal did any further testing... they said my blood sugar went to normal...

[jmjm530]

CO,

I thought u could do better than that. BTW I accept PayPal.

Port,

Thanks. I've got to study up a bit on bp drugs before my next cardio visit so I can guide him properly :) It does seem like some hospitals are pro diuretics and others are def anti and will prescribe Ace Inhibitors first. Hopefully, this is more  philosophical than economical as there is no money in diuretics but much money in the more exotic bp meds.

-- Jim

[CoWriter]

Jim: Of course it your ACE isn't doing its job then you have to change, what will be your next drug of choice?

Port: Avocados
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ROFL

[CoWriter]

"BB is super RVR so either you're wrong about that, or he was not IR going into treatment or had it under control."
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Hypoglycemia is a sign of TRANSIENT hyperinsulinemia.  


"so either you're wrong about that"
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Not today...LOL

Co

[portann]

I'm not fool enough to become an ACE groupie but I like what I read.

It helps a bit that my cousin, who's adored me since we were little but is excessively blunt, is co-director of a cardiology/metabolic syndrome clinic and likes ACE inhibitors. (BTW, he hates that my husband is taking niacin for his cholesterol.)

He's only a specialist but at least he distrusts drug bandwagons as much as I do. Distrust runs in the family.
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In answer to your questions:

Jim: I'd be interested in anything you have regarding problems with ARBs.

Port: I remember one article about interaction with ACE, the other about ARB not as good as ACE, but useful if ACE can't be tolerated. You know I'm a lightweight but will do my best to find them. Tomorrow?

Jim: (1) What strength did you try and was it suggested to titrate up?

Port: Started with 2.5 ramipril, and increased every two or three weeks due to resistance in diastolic. 5 ramipril, now 7.5 and doctor wanted me to go up to 10 ramipril but still haven't done it. Afraid to pass out with too beautifully low systolic and stubbornly high diastolic.

Jim: (2) Any side effects

Port: Transient dry cough (a week?) but was really not a nuisance.

Jim: (3) Did it bring down your systolic and how much?

Port: December 14, 2008, 157/101; January 04, 2009, 118/87, January 30, 2009, 96/76.
I want to be at 75 diastolic but feel faint with 96 systolic.


Jim: (4) Have you tried diuretics either with it, or alone? I've read a diuretic can amplify the effects of the ACE but maybe it's just additive.

Port: I do take Ramipril with a baby diuretic to counterbalance high potassium problems with ACE; currently taking 1.25 mg indapamide, down from 2.5, due to potassium going TOO LOW!  Low potassium is the pits. Very easy to fix the low, though.

Jim: Of course it your ACE isn't doing its job then you have to change, what will be your next drug of choice?

Port: Avocados

[CoWriter]

"Co, if ACE's are so much in the cardiology eye, why wasn't he prescribed one?"
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I have no idea.

Co  

[CoWriter]

This is starting to turn into an interesting thread, isn't it?

I'm very thrifty.  I don't even pay for studies.

Co

[CoWriter]

(see my previous post to Jim)

Back in October, what kind of blood test did they do?  What was your fasting blood sugar?  Did they check your insulin level?  How about a 2 hour glucose tolerance test?

You see....when you become insulin resistant (insensitive to insulin), the pancreas works harder and produces more insulin....and sometimes it makes too much and that causes your blood sugar to go down too low.....like maybe 40.

Co

[jmjm530]

You are on record as saying that the chances for RVR are close to zero for someone who is IR going into treatment. BB is super RVR so either you're wrong about that, or he was not IR going into treatment or had it under control. Which is it and I won't even charge you $23.

[CoWriter]

I found a post written by  BklynBoy81 back in October that says....


"Mom is a diabetic so i get to check my sugar levels once in awhile.. The one reason i found out that i was Hep C Pos was because my sugar would drop to 40.. 40 is kind of scary so i thought i was a diabetic or hyperglycemic and so i got some blood work done"

Now....what were you saying about him not being insulin resistant?

Co

[portann]

I'm home and catching my breath. Hate stairs.

Vertex says NO to only one particular class of blood pressure medication called CALCIUM CHANNEL BLOCKERS. Everything Vertex lists belongs to this class.

So in a nutshell, don't take any calcium channel blockers during treatment, according to Vertex. Simple.

I'm willing to accept that at face value, since I'm not a fan of that class due to tachycardia as a side effect.

The other broad classes are:

1) diuretics
2) betablockers
3) ACE inhibitors
4) ARB's

I have to say diuretics are often the first line of tx in the U.S., so the fact the trial didn't prescribe it but a betablocker instead is interesting. I'm still puzzled if there's a rationale for prescribing a betablocker for BB during tx, given that it's not commonly prescribed anymore.

Co, if ACE's are so much in the cardiology eye, why wasn't he prescribed one? Yes, I love everything I read about it but here I am resistant to it during tx. Sorry to be a pain but I'm perplexed and frustrated at taking the creme de la creme and getting lousy results.

TTYL

[CoWriter]

"Has anyone told you that you see life through IR colored glasses LOL"
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ROFL....never that nicely.


"I do think it's an important topic but "
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It's THE most important host factor in the prediction of response.  I would say it's important.


"especially if someone RVRd."
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"Exquisitively sensitive to interferon".  Exquisitively sensitive to insulin is what I think they are....LOL  You'll see....one day I'll be proven right.  


"Someone posted a few weeks ago that their doctor already has one patient who needed a transplant, the damage caused by one of the IR drugs."
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I'm going to have to set a limit to how many times I argue the same topic with you.  And I'll start charging you $23 every time you go above the limit....LOL

Avandia can cause liver failure.  There are 14 reported cases....but NONE with Metformin.

Co

[CoWriter]

There's a list at the bottom of the page of some commonly used....

http://en.wikipedia.org/wiki/ACE_inhibitor

Co