A-Z

Kidney health

Controlling blood pressure

High blood pressure (hypertension) is a common cause of kidney impairment. Conversely, as the kidneys play a role in blood pressure regulation, kidney impairment can also lead to high blood pressure. Therefore it is common for people with kidney impairment to also have high blood pressure, and controlling blood pressure is an important way of preventing kidney impairment from worsening. Most people who have kidney impairment are prescribed medicines to lower their blood pressure, because even small increases in blood pressure can have a big impact on kidney health.

Most of the people we spoke to with kidney impairment also had high blood pressure. Some were living with other long term conditions too, such as diabetes, heart disease or arthritis, resulting in them having to take lots of different medicines, including blood pressure lowering drugs.
 

Harry describes the various medicines he takes for his heart problems, high blood pressure and arthritis. He doesn’t mind taking his tablets and it has become part of his routine.

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Age at interview: 78
Sex: Male
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What you’re taking when and what’s it’s actually for.

Right, in the morning, I take a ten milligram amlodipine tablet, a twenty milligram atorvastatin. Oh sorry, I take that one at night so it’s, I also in the morning I take a bisoprolol, I think that’s how you pronounce it.

Bisoprolol [laughs].

Five milligrams and enalapril maleate I take twenty milligrams of that once a day in the morning.

What’s that for?

To be honest, I don’t know without reading the paperwork. It’s something to do with controlling blood pressure, I think. In addition, in the evening, I take the… atorvastatin, which is obviously a statin, and I also take, five, at the present time, five milligrams of warfarin daily. The only other thing I- I take either co-codomol or tramadol as a painkiller just before I play golf or I do anything fairly active because that otherwise I get, I tend to get very painful ankles. from arthritis and so I use that just to, you know, help me, and I don’t- I obviously, whilst I have a golf handicap, I don’t want to, I want to stay at a certain level. [laughs] And that helps me.

How easy is it to take your medication as prescribed?

No problem. It’s very routine. I don’t even think about it. They say take it with food, so I have the three tablets with my breakfast, and then in the evening I have the other, and it’s just so routine now I hardly think about it.

And have you ever experienced any problematic side effects from any of your medications?

Not at all. I thought that my aching ankles might have been a bi-product of one of the tablets but the GP thought not and he thought it was just arthritis and my age [laughs].

And did the GP prescribe you the co-codomol and tramadol for that?

He did indeed, yes, and I’m careful not to take it unless I need it because I, these things I know can be addictive, so you know, I usually take two tablets probably an hour before I play golf or I do something active, which is likely to cause me a problem.

And how do you feel about taking all these different medications?

No problem. It’s so routine, I wouldn’t give it a thought really. And I assume they do what they are supposed to do. I don’t know, if I didn’t take them, what the effect would be [laughs], but I’m being advised and, you know, I trust in the GP. And… most of the tablets I take were prescribed to me when I had my last heart problem, when I was abroad, and I virtually kept on the same tablets since I came back. They thought they were as good as anything that I would be given here so I’ve been prescribed the same tablets.
 
People commonly said that they had felt unhappy at first about having to take medicines, but over time they had learned to accept that it was necessary to keep them well. Roy had been concerned to learn he needed treatment for high blood pressure and cholesterol because cardiovascular disease runs in his family. Justine had felt far too young to start needing treatment for long term conditions when only in her early forties. John would have preferred to lower his blood pressure through exercise and diet but his GP suggested taking medicines would be more effective.
 

John had been reluctant to take medicines at first and talked to his GP about possible side effects and the risks of refusing treatment. He has now become used to taking his tablets.

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Age at interview: 75
Sex: Male
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And how do you feel about being on medication?

I didn’t want to go on it because I I’ve got to seventy four without taking anything. I suppose I saw it as a sign of weakness thing that I had to start taking medicines. … But no, I don’t- I don’t mind now. No, I’ve got used to it now.

So how involved were you in the decision to have the medication? Did you, what kind of discussion did you have with your doctor?

Well, I had quite a long discussion with the GP because I was a bit reluctant. But he did he did he didn’t try and force me into it. He said, “Well, I’ll leave it up to you.” …And the way I think is, what’s the point of going to the doctor if you’re not going to take any notice of what he tells you. I mean I talked to some of the old boys up at the golf club… and they’re on statins and they’re all moaning about the aches and pains and leg muscles don’t work and they get pains. …But I’ve never had any problem and why would I listen to a couple of old duffers at the golf club rather than the GP, you know, so.

What were your main concerns?

[Sighs] side effects.

And so that was particularly about aches and pains that you heard from...

No, any side effects because my mother, she had rheumatoid arthritis for thirty years and she was on all sorts of… medication and, eventually, it ruined her kidneys. She died of kidney failure when she was… sixty seven. Purely because of the medication. And, when I spoke to the doctors about it and they said, “Well, she had thirty years of…relatively… pain free life, what would you’ve rather had? You know, she lived longer or and was in pain?” So, and I know all medicines have got. Side effects of some description, you know, but I don’t I don’t appear to have any side effects with either the statins or the- or the ACE inhibitor.

Did the GP offer you any information to reassure you about possible side effects or convince you about why it would be a good idea to take that medication?

Well, he didn’t really much talk about the side effects but he did convince me that it was… it was better than having a heart attack.
 
Other people said they still disliked having to take medicines even after many years. Donald wished he could reduce the number of medicines he was taking.
 

Pat said she doesn’t like taking pills and would be inclined to only take those she considered most important if it wasn’t that her husband ensures she takes them all. She calls them her ‘staying alive tablets’.

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Age at interview: 62
Sex: Female
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And how do you feel about being on this amount of medication?

I'll don’t like taking these tablets, I've got to say. I'm not a very good tablet taker; I won't take paracetamol, I don’t take nothing. My husband makes sure I take those tablets every day.

He checks with you?

He checks my pots; he puts them all in the pots and he checks the pots and he makes sure that I take them every day. Otherwise I wouldn’t bother. Because I would only take the most important ones and the most important to me is the one that thins my blood. Yeah I don’t like taking tablets, I've got to be honest, but then I take them.

Well I was just wondering whether you'd ever said to the doctor, "Do I really need to take this?”; “I am not keen on taking this."

I don’t like taking any of it. What I was told… that’s my staying alive tablets. And so hence the reason I take them but I've got to say no I don’t really like taking them but that’s what they're called; that’s what we call them, that’s my staying alive tablets.
 
Sarah liked to find out information and weigh up the pros and cons of taking particular medicines. Harry said he always asks his doctor questions about his medicines, and his wife says they always read the leaflet in the packet to learn about possible side effects. Pat preferred not to know this information. Peter felt that doctors sometimes made treatment decisions without asking the patient’s preferences.

Some people negotiated with their doctor to try lowering the dose of a medicine or stop it altogether. Jim B took a break from blood pressure tablets during which he controlled it using diet, exercise and meditation, but after a year was advised to take a different blood pressure lowering medicine. Anne and Peter, who were taking diuretics (water tablets) to treat high blood pressure or other conditions, had been given permission by their doctor to alter the dose themselves on a day-by-day basis depending how much fluid retention they were experiencing. Lesley had done this without telling her doctor because she finds she has difficulty sleeping when she takes too many diuretic pills, and her arthritis seems more painful.
 

Jackie Z takes propranolol to prevent migraines, which it does by lowering blood pressure and heart rate. After discussion with her doctor she tried taking it less often but her headaches returned.

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Age at interview: 70
Sex: Female
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Have you ever refused medication that was offered to you because if you didn’t want to take it or didn’t need to take it?

I have gone down and said, "Do you think I could do without this, would it be wise?" and he said, "Well try taking it every other day, see what effect it has," you know, that’s… it's just a conversation really.

And what was that, what medication?

That was the beta-blocker, the propranolol.

Hm mm for the migraine or against the migraine?

Yeh but when I stopped taking it the headaches came back so I now I know. So I won't stop taking it and nobody has suggested that is a danger in continuing to take it.
 
 

Peter takes water tablets to reduce build-up of fluid in his heart and lungs but if he takes too much it harms his kidneys. His doctor suggested that Peter should vary the dose according to how he feels.

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Age at interview: 50
Sex: Male
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So have there been any other ways in which you’ve been affected by the medication?

Only by the- well, only by the water tablets. Because they must be like- a very like a very powerful drug because if you take too much of them they can damage your kidneys. So it's a constant battle to try and get the levels right. I was up to four tablets a day, because I was getting a lot of water on my lungs. So you couldn’t sleep at night so you took more tablets. But four is quite a lot of tablets to take? But I'm now down- the doctor- my last appointment the doctor said, "Well you can play about with them yourself how you feel."

OK

"And if you feel you’ve got to take more then take more… but, obviously if you can take less it's better for your kidneys," so, I've cut down to two and a half tablets a day now. …And at the moment, for the last couple of weeks I have been feeling really good. Apart from I still get very breathless.

Yeah

Yeah.
 
Alongside their useful effects, most drugs can also cause unwanted side effects, but not everyone experiences them. There are many different medicines that can be used to treat high blood pressure. The possible side effects vary between medicines and people react to medicines in different ways.

Many people we spoke to said they had experienced no problematic side effects of their medicines. Some recalled having side effects when they first started taking a medicine but which later wore off, such as ankle swelling, headache, nausea or a dry mouth. Other effects might be experienced only occasionally or were not particularly troublesome. For instance, Ken had sometimes felt light-headed in hot weather, and Laura felt generally colder than she used to and once became dehydrated without realising it. If side effects are more problematic people may be taken off a particular medicine and tried on a different one instead. Justine was taken off nifedipine because it made her feel dizzy and nauseous. Robert was taken off a beta blocker because it made him feel like a zombie, and Gerald because it caused him breathing difficulties. Roy said the first blood pressure medicine he took made him feel drowsy and hot.
 

The first blood pressure medicine that Tony took made him feel dizzy. The second one he tried gave him a dry mouth. He is now taking a medicine that does agree with him.

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Age at interview: 74
Sex: Male
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Yes, the symptom was, the first tablet I took [nifedipine], I took it half past seven in the morning, I did a morning’s work, came back home, walked into town and then came back home. And the whole of, in my city, one of the ancient [gatehouses] started going round and round. I then managed to walk back home, sat down on the settee and, to put it in generalisation, you would just think you’d been on the beer all night because the room was going round and up and down and everything. I was then told by the GP not to go to bed, lay down, but sit, relax and the tablet would go through, go through the process, and by 5 o’clock of the same day I would be able to read the paper, watch the television. And so that is eventually what happened.

Persevered with this tablet for a fortnight. Then a review between the consultant and the GP it was established that this was not the right tablet for me. I then went on to another tablet, which did agree with me, and taken that for quite some time. I then went on to another tablet [felodipine], again very short tablet, didn’t agree with me, which gave me a very dry mouth and any food or drink I took I couldn’t say I was getting any enjoyment out of taking even a simple thing like a cup of tea, it felt like poison. I stopped those tablets, told the GP, and from there we went on to a tablet that has agreed with me [indapamide]. And we are now in the process of going on to a further tablet which will even bring the blood pressure down more.
 
 

Kath lived with a bad cough for two months after starting on blood pressure medicine; her GP suspected it was a side effect so moved her onto a different medicine.

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Age at interview: 72
Sex: Female
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Because I had, when I’m on blood pressure pills, which have kept my blood pressure quite normal for quite a long time, but the first time I went on them, I developed the most dreadful cough… and, after I’d had the cough for two months, I went to the doctor and he listened to my chest and everything and said it was fine. And he said, “If you’re still coughing in a fortnight, come back and see me again.” So I did that and he was just filling in the form sending me to an ear, nose and throat specialist and he said, “Hang on a minute, when did I put you on the blood pressure pills?” And so I told him and he said, “It could be a side effect of the blood pressure pills.”

So he changed those and, since then, because if, I, it had never occurred to me that coughing could be a side effect of blood pressure pills, I do tend, if I’m put on new medication, to look at what the side effects are but otherwise, I’m afraid I don’t tend to read it.
 
Some types of blood pressure lowering medicines can also reduce the ability of the kidneys to filter waste products from the blood, but a small reduction in the estimated glomerular filtration rate (eGFR) (see ‘How and why is kidney function monitored?’) can be tolerated because these medicines offer long term protection against cardiovascular disease. However, people may occasionally experience a bigger drop in their eGFR and should stop taking these types of medicines. For instance, tests showed that Jim B’s eGFR had dropped to a low level while he was taking ramipril but it rose again after he stopped taking this medicine.

It is usually recommended that blood pressure medicines are taken at roughly the same time of day every day, but this can be hard to remember. People described having a routine to help them remember, such as keeping their medicines on the bedside or kitchen table to take in the morning or at bedtime. Remembering to take medicines in the middle of the day could be more difficult, especially if people were away from home. Laura said that having the days of the week printed on the blister pack that the pills came in helped her to know whether she had taken it not, although on occasions she thought she had taken two of the same tablet.
 

Martin’s ACE inhibitor tablet has to be taken 30 – 45 minutes before eating, so he does that before breakfast; he takes soluble aspirin with breakfast then a bisoprolol tablet afterwards, and simvastatin at night.

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Age at interview: 70
Sex: Male
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And how easy is it to take your medication as prescribed?

Oh it’s very easy. Yeah, it’s not a problem. The only inconvenience is in the mornings, I have to the perindopril, I have to take it thirty minutes to forty five minutes before I have any food. So I tend to get up early or I take it up to bed with me at night so I wake up in the morning, I got some water and then I knock it back. And then I eat after about forty five minutes. The rest of, I then I then take a soluble aspirin with my breakfast.

Because, obviously, aspirin can cause internal bleeding. But it’s only a very low dose so I always take it with food. And then after I’ve taken that, I take bisoprolol. I take the simvastatin at night, which is what I’m told to do, and so it’s not a problem, you know. I’m used to it now.

What helps you remember taking it?

Well, I don’t, I do it just automatic I think. I just, I’m into the routine. I’ve been taking it for what probably a year now. And it’s really not an issue for me. There have been occasions I think when I’m- “ have I taken the tablet or not?” You know, I mean I sort of go and have a look at the thing and say, I think, I think I’ve taken it, yeah.
 
 

Ian takes his diabetes and blood pressure tablets immediately after doing the washing up in the morning and evening.

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Age at interview: 82
Sex: Male
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Did you get prescribed medication for it?

Yes.

Do you know, that’s a medication you’ re still taking now?

Yeah.

Do you know what it’s called?

There’s metformin and… what’s the other one? …ramipril, ramipril is the other one.

And that’s something you take every day?

Yes.

Do you do you know your dose?

Two tablets every morning of metformin and two at night. And ramipril is one per day.

And do you experience any side effects from taking those medications?

No. I’m very lucky. I can take pills without any trouble. Yeah.

And have you got a special strategy of how you remember taking them? …Or is that not a problem?

No, it’s no problem. I’ve got a… a box of pills. Every morning, when I wash up, at the same time as I wash up, I get all the pills down and leave them there. As soon as I finish washing up, I open the pills and take each one out, put them all back, same thing in the evening, as soon as I do the washing up.

[Laughs]
 
 

Laura takes two different medicines each night to control her blood pressure. Sometimes she has mistakenly taken two of the same tablet, which has caused a headache the next day.

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Age at interview: 60
Sex: Female
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So how many tablets do you take each day?

I take, I take two at night and I’ve always taken them at night, and that’s great.

Any problem with taking them?

Well it’s boring. I’ve got the days, I think it’s really important to have the days written on your tablets so that you know that you’ve taken it or that you haven’t taken it, because there are times when I’ve not been sure whether I’ve taken it or not. Or there was one time when I thought I’d taken two lots and I, I waited for ages in in an emergency unit and nothing happened and I went home eventually because they didn’t see me. But yes I think, I think to actually have the days on helps so you know whether you’ve taken it.

There have been times when I’ve mistakenly taken two of the same tablet. And what has happened at those times is I get a headache. And I’ve eventually learnt to notice this if I’ve got this headache; it’s a bit like a hangover, if I’ve got this headachey hangover thing it’s probably because I’m taking my pills wrong, and I need to look, and I’ve done that, I must have done that four times, I suppose that’s not very often in 16 years. If I had to take blood pressure tablets when I was younger, I think that would have been very difficult because I was, you know, I’d I was a lot more irresponsible and I’d have to be carrying my blood pressure tablets with me all the time to make sure I’d take them, and I think I would have forgotten them, yes. Where they’re now at my bedside so that it’s a little ritual that every night I’ll take my tablets just before I go to bed. So and there’s been times when that’s, like when we went to the States, that was difficult to remember when you’re on a plane or, and then I was wondering what to do because I'd got an eight hour time difference, and things like that.
 
Others used the compartments of a dosette box to put out ready the pills they needed to take on a daily or weekly basis; Bernard and Pat said their partner did this for them.
 

To help him remember to take all his medicines Simon organises them two weeks in advance using a dosette box. Swallowing them can sometimes be a problem, as can dropping them on the floor.

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Age at interview: 56
Sex: Male
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So it’s quite easy to remember, once I’ve got everything sorted out, but I suppose if I got a bit older, the more forgetful I’d get, I’d get the pharmacy to blister it for me. But I quite enjoy, actually, putting it all in the dosette box.

So you use one of those dosette boxes?

I do it on a two weekly basis, yeah. Yeah, yeah.

Does that make it easier?

Yeah, well, I take my warfarin at tea time, so my warfarin is in the kitchen, so the only time I’m likely to forget it is if we go out but that doesn’t happen very often. So it’s like when I get in from work, I take my warfarin, and then everything else is in the box.

So…

Four section boxes, one for the morning and one for the evening.

Okay so how do you feel about being on so many medications?

I don’t like it. Nobody would, would they, really? I mean it’s just a heck of a thing to have to keep remembering. No, swallowing is sometimes a problem and if you do, you know, take your tablets last thing at night and you don’t switch the light on and you maybe drop one on the floor, that’s a bit of a pain. One of the other big pains regarding the tablets themselves is that the 200 milligram tablets of lithium are exactly the same in diameter and shape to the doxazosin I think, yeah, I think it is the doxazosin, little, you know, oblong capsule type shape. But hey ho.

And…

[Laughs]

Taking all your meds on work days is not a problem?

Well, no, because I take the sotalol before I get up and I’m home before I have to take my warfarin. So yeah.
 
 

Royston Y puts a week’s supply of all his pills into a wooden box and can tell by the size and shape of the tablets whether he has taken them all or not.

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Age at interview: 82
Sex: Male
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So how easy is it to take your medication as it’s prescribed?

Very simple.

How many pills is it a day?

Four. Three in the morning, one at night.

And you don’t mind --

No.

-- four pills?

I’ve got it well organised [laugh].

Good.

Yes.

Do you ever forget? Is it easy to -

No, no, I’ve got my own little system which works very well.

Can you describe your system?

Yes, yes, I’ve got a box, a wooden box and I put a week’s supply in there of my tablets. And I can check each day just to see that if, whether I’ve m-, they’re all different shapes, so I can see that if I’ve missed one, which has,  has happened very occasionally, then, okay, according to the things you shouldn’t take two in-, instead of, instead of one. So if you miss one, so what?

Neither here nor there.

Yes, so you know, as I said, my, my own system works well.
 
Some of the people we interviewed had only recently started taking blood pressure medicines, while others had taken them for many years and said their blood pressure was stable or well controlled as a result. Jackie had taken them since childhood. Flo and Margaret had been treated for high blood pressure when they were pregnant but not again until later in life. Some people said that reducing sources of stress in their life had helped to lower their blood pressure. Robert says his blood pressure has come down since he retired from work.
 

Justine is aware that if she has lots on her mind her blood pressure rises; as a result she has tried to adopt a more relaxed approach to life and allow more time to get things done.

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Age at interview: 44
Sex: Female
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And do you have a sense of what your blood pressure is doing? Is there any way you can tell whether it's high or low?

I suppose- the only way I can sort of tell myself… I suppose if I'm just sat on an evening watching tele and then chilling out for an hour before you go to bed, then I know my blood pressure's going to be lower. If I've got a lot of things on my mind , I don’t mean as in like worrying stuff, I mean as in, right I've got to go and do this and I've got to go and pick up this, or buy that.

Just being busy?

Yeah just general things and “oh I've got to finish this report for my other activities that I do on my computer” and things like this. Then I know in myself that that’s getting my blood pressure up. … I don’t feel stressed or anything like that but I just know that that’s- and it's made me more conscious now of the things I do that it’s affecting my blood pressure so it could be affecting my kidneys.

So what kinds of changes have you made since you were told that you need to bring your blood pressure down?

I've…I’ve- think well, a) life's too short to worry about sort of too much things anyway so I… I've now said, "Well if I can't do things, I can't do them." It's not the end of the world just because I haven’t posted this letter today or I can wait till tomorrow or… I haven’t sort of … because I do… a lot of computer work for a youth organisation I run, and I've got deadlines for certain things and I'm thinking, 'At the end of the day it's not my job; it's not a hobby… it's a hobby sorry, it's not a paid job so if I don’t get it done, I don’t get it done any more,' you know? It's like I still- but I allow myself more time to get it done rather than try and rush it and leave it to the last minute.

You’ve adopted a slightly more relaxed pace?

Yes, sort of- yeah I think so yeah, definitely.
 
Last reviewed August 2017.
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