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 Rebound hypertension occurs when the blood pressure rises after stopping or lowering a blood pressure medication, including the use of emergency blood pressure medications. Let’s meet John and Jerry, two patients who are experiencing rebound hypertension.
John’s Story John Smith is finishing out his career as a police officer and is looking forward to retiring with his wife, Jenny. He is passionate about being a police officer and works diligently to maintain his health. John loves to watch football, hike with Jenny, or golf with his buddies when he is not working. Despite his efforts to stay healthy, John’s blood pressure continually increased and he was diagnosed with hypertension seven years ago. He was put on medications to lower it and he has since been stable. However, in the past year, he has experienced spikes in the 180s, well outside of his normal range of 120s-130s. With these spikes, he was experiencing headaches and his heart would race. His nephrologist prescribed him an emergency relief drug, Clonidine, a short-acting drug that reduces blood pressure quickly. The Clonidine seemed to work for John when he experienced his blood pressure spikes. His blood pressure would return to its normal range, as intended. Not long after that, John would begin feeling another headache. He would take his blood pressure again and his reading was back into the 170s. “That’s odd,” John thought to himself. “I just took my medication and it was back to normal.” This happened two more times in the coming weeks. He called his nephrologist and explained what he was experiencing. Jerry’s Story Jerry Williams is a retired accountant. She spends her days watching her 3 grandchildren, reading, and baking. She is diligent about looking after her health and overall wellbeing. Jerry was diagnosed with hypertension three years ago and was put on medication to control it. Along with her medications, she also implemented daily walks and swimming, when the weather allowed and worked to reduce her sodium intake. Jerry’s blood pressure did well on the medication regimen and she saw significant improvements when she added the recommended lifestyle changes. Her blood pressure has begun dropping into the 100s and she experienced dizziness and lightheadedness. At her next appointment, her nephrologist took her off of her blood pressure medication to help bring her blood pressure back up and stop her new symptoms. After her medication reduction, Jerry noticed her blood pressure was elevated, with readings consistently in the 160s. “We only adjusted one of my medications,” Jerry thought. “Why is my blood pressure acting like this?” She notified her nephrologist and went to be seen for another appointment. At their respective appointments, Jerry and John heard this from Dr. Munjal: “It looks like you are experiencing rebound hypertension. Rebound hypertension occurs when the blood pressure rises after stopping or lowering a blood pressure medication. The good news is that this tells me exactly what I need to know.” For Jerry, the current dose is too much and zero is too little. She was put back on her medication and started the weening process. John had one of his other regular medications adjusted to reduce the potential for the spikes and saw a reduction in his emergency medication use. What we can learn from both John and Jerry is that blood pressure is not one size fits all. We expect changes to happen over time which is why rebound hypertension tells us just as much as the initial diagnosis. It helps us make adjustments to keep blood pressure stable as the situation changes. Not everyone needs the same types of changes, so it can take a few tries to get the medication dialed back in to meet each patient's specific needs and circumstances. If you are experiencing rebound hypertension, please contact your doctor to discuss or go to the ER if you experience a hypertensive crisis. As always, stay safe and healthy! Resources: https://medlineplus.gov/ency/article/000155.htm#:~:text=Rebound%20hypertension%20occurs%20when%20blood,like%20beta%20blockers%20and%20clonidine. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-treatment/drc-20373417  According to the CDC, approximately 129 million people in the United States have at least one chronic disease like cancer, hypertension, diabetes, or heart disease. That is almost half of the entire population. Many chronic illnesses are accompanied by a number of comorbidities as well. These illnesses require constant attention, both mentally and physically, to maintain balance in the patient's life. Let’s explore some of what reality may look like for some people.
Habits Having a chronic illness often means that patients have to develop healthy habits and routines to ensure they are staying on top of their healthcare between appointments. This can look like:
Appointments and Labs Chronic illnesses often mean additional appointments with primary care, a variety of specialists, treatments or infusions, and labs or imaging. We often hear that many of our patients have an appointment a day every week for themselves and their spouses. Can you imagine how limiting that can be on someone’s personal schedule? Remission and Relapse As we age, our bodies naturally change over time, whether we want them to or not. Blood pressure, especially, is an ongoing, ever-changing thing. It is only a matter of time. Seeing a decline in lab results or changes in blood pressure can be disheartening, especially when a patient has been “doing all the right things” to keep themselves on track. Importance of Monitoring Regular monitoring by patients and doctors together is vital to ensuring that we are able to catch trends and intervene sooner rather than later. Programs like Remote Patient Monitoring help us track changes more closely and identify trends early. Monitoring does not replace regular appointments, but is an incredible tool in assisting your care team in seeing the bigger picture of your health. However, a formal program isn’t always necessary. Tracking daily weight and blood pressure readings at home also help in the decision making process. We want to know what readings look like on average in a normal, day-to-day setting. In an office, there can be multiple other factors contributing to different weight and blood pressure readings, like additional shoes/clothing, eating/drinking, traffic, White Coat Syndrome, etc. This is not to say that these readings are inaccurate, but seeing the home-setting trends are equally important to avoid over- or under-medicating. Considering all these patients have to go through, manage, and keep track of, they deserve an award for handling their lives and continuing to push forward. Share a smile or warm hug and offer assistance to others when you can: you never know who may need it most. Resources: https://www.cdc.gov/pcd/issues/2024/23_0267.htm  To understand uric acid, we must first understand where it comes from. Uric acid is a waste product from the body processing purine. Purine is a naturally occurring compound found mainly in meat products like beef, fish, and poultry. If you have a diet that consists of a large quantity of foods that are purine-rich, you are more likely to have high uric acid levels in your blood. With healthy kidneys, this generally is not a problem. However, high uric acid can lead to some painful problems down the line, like gout and kidney stones.
Common Foods High in Purine:
Gout is a complex form of arthritis caused by the development of uric acid crystals due to high levels of uric acid in the blood. These crystals settle in the joints, commonly the big toe. The settlements can cause gout attacks, or flare-ups, of discomfort, pain, swelling/inflammation, and discoloration of the joint. Gout attacks can last 1-2 weeks, but may last longer depending on treatment and severity. Kidney Stones Uric acid kidney stones form when there is too much uric acid present in the urine and/or when the urine is too acidic on a regular basis. Once these kidney stones form, some may pass on their own, but others may require intervention from urology. Symptoms can include: Severe pain in the sides/lowerback, flank or stomach pain, fever, nausea/vomiting, urine that smells or looks cloudy, or blood in the urine. Prevention and Treatment Preventing uric acid build-up can be as simple as being mindful of your consumption of the purine-rich foods listed above. Prevention can also include weight management to reduce the risk of kidney stones. If dietary changes are not sufficient, there are medications that can be prescribed that can help lower the uric acid as well. If you have kidney diseases, please consult a nephrologist for treatment options. As always, life is about balance and enjoying everything in moderation. If you have concerns about your uric acid levels, contact our office today to schedule an appointment with Dr. Munjal. Stay safe and healthy! References: https://www.kidney.org/uric-acid-stones#:~:text=A%20uric%20acid%20stone%20is,smells%20bad%20or%20looks%20cloudy  Did you know that there are more than 30 unique benefits to walking daily? Sounds too good to be true for this seemingly simple exercise, right? As a team, we embark on a challenge to be healthier through the holidays and we want to challenge you too! We know we will be indulging in sweets, rich meals, traveling, and off of our normal schedules in the coming months, so we are trying to get ahead of the curve. Incorporating more steps into our daily routine is one of the easiest ways to create balance with all the treats this season. Throughout our challenges, our team has seen a number of benefits like weight loss, decreased resting heart rates, improved oxygen levels, increased stamina, and noticeable muscle tone.
The first few weeks of building a habit are always the hardest, especially with the stress of the holidays upon us. “How can I possibly work something else into my already busy schedule?” I’m glad you asked! Below are 8 ways you can make choices that can increase your step count for the day!
Still not convinced? Check out these facts about walking for some extra motivation to lace up those sneakers!
Moving your body and staying active during this season is so important for your physical and mental health. Once you get up and in the habit of moving, you will find yourself craving the benefits daily. After all, a body at rest stays at rest, while a body in motion, stays in motion. How will you get to stepping this holiday season?  The holiday season is such a wonderful time of year to share love and reflect on the events of the year. The holidays often include celebrations, travel, and indulging in lots of rich, decadent foods. These deviations from our routines and normal habits can begin to affect our health, like increased blood pressure and fluid retention, if we are not mindful of our restrictions and doctor recommendations. Listed below are some helpful tips to keep you safe and healthy this holiday season.
Sodium and Fluid Did you know that a single restaurant entree typically contains 50-100% of a full day’s recommended sodium content? If you're eating out at a restaurant, split your entree in two and only have half; save the other half for leftovers on another day to avoid excess sodium. It is equally important to keep the sodium low for your other meals throughout the day when you do go eat out at a restaurant. Additionally, sodium can be hiding in the preservatives of the snacks and fast-food we may be eating outside of our normal routine. If you are cooking, try to use as many whole, fresh foods that you can and replace salt with other dried or fresh herbs, spices, and vegetables (garlic or ginger). Learn more about sodium’s secret identities here. As always, moderation is key! Additionally, it is important to be aware of your fluid consumption. We don’t just mean water. Fluids can include tea, coffee, juice, soda, alcohol, broth, and more. For those with fluid restrictions, please adhere to your prescribed diet. For additional information about fluids and fluid intake click the links below: Medications and Appointments Now is the time to check on the status of your medications! We recommend requesting refills of medications at least two weeks in advance to account for holiday pharmacy hours and office closures. Additionally, appointments may be required for refills if you have not seen your physician recently. Be sure to give yourself time to be seen by your prescribing physician. It is important to note that virtual appointments are still covered through the end of the year for those with traditional Medicare coverage and are included in most private insurance plans. For more information on how to stay healthy through the holidays, check out the additional posts below! As always, stay healthy!
 Calling all jet-setters, road-trippers, and stay-cationers! Do you know how to stay safe this holiday season while traveling? We’ve laid out some helpful tips and tricks to make traveling this holiday season a breeze.
Travel There are so many things that can go wrong when we travel, like lost luggage, delayed flights, flat tires, and unexpected detours. It is important to be prepared for sudden, unexpected changes in plans. Preparations for these situations can include bringing your entire bottle of emergency relief medication and monitoring devices, like scales and blood pressure monitors, with you. We always encourage monitoring yourself while traveling as you may see changes in readings and symptoms due to changes in eating, drinking, and stress that may require emergency relief medications, like diuretics or antihypertensive drugs. If you are on our Remote Patient Monitoring (RPM) program, our devices are travel friendly and will transmit from all over the world. General Health and Safety Staying safe is a no-brainer when traveling. Listed below are some general travel and safety tips:
We wish you a happy holiday season and a happy New Year! As always, stay safe and healthy!  A comorbidity is defined as a medical condition that coexists alongside a primary diagnosis. These conditions can develop over time and potentially worsen your pre-existing diagnosis. Properly managing your health conditions can help reduce the risk of developing comorbidities or reduce the impact they may have. Let’s explore a few common comorbidities that impact kidney health.
This is by no means a comprehensive list of contributing factors and influences on kidney diseases. Each person is unique and requires individualized attention based on their needs and pre-existing conditions. If you have concerns about your kidney function and comorbidities, reach out to our office to schedule an appointment with Dr. Munjal. As always, stay safe and healthy! Resources: https://my.clevelandclinic.org/health/articles/comorbidities https://journals.physiology.org/doi/full/10.1152/ajplung.00152.2021  Health insurance is a vital part of getting the care that you need to stay healthy and happy. Open enrollment for health insurance plans typically starts November 1st and runs into December. However it is important to do your research beforehand so you are prepared when it comes time to choose a new plan. Listed below are our top three points to consider and remember when researching health insurance plans.
Resources: Florida Medicaid: https://www.flmedicaidmanagedcare.com/ Medicare: https://www.medicare.gov/ National Insurance Resources: https://www.healthcare.gov/ If you have any questions or concerns about your insurance coverage with our office, please call your insurance provider for plan-specific information.  Halloween kicks off our season of holiday sweet treats and indulgences. It’s important to know what sweets are tricks and treats, as well as how to satisfy a craving in a more kidney-conscious way.
Sweet Treats: When searching for a sweet treat this holiday season, the candies listed below are safer options for those who have kidney diseases. Remember, everything in moderation!
Spooky Sweets: These sweets may give you a spook! The options listed below are not the best choice and should be avoided when possible. For patients with kidney diseases, these candies can pose potential problems as they contain higher levels of phosphorus and potassium due to being made with solid chocolate, nuts, dried fruit, coconut, peanut butter, and caramel.
DIY: Healthier options The National Kidney Foundation has some fantastic seasonal recipes that are kidney-friendly to satisfy cravings and keep you on track. Moderation is key! The ‘fun size’ portions are approximately 1 ounce which is just right. When you can, opt for sugar-free options or renal-friendly fruits based on recommendations from your nephrologist or dietitian. As always, stay safe and healthy! Resources: https://www.kidney.org/nutrition/recipes  Meet Jane Doe. Jane is a 55 year old teacher living in Jacksonville, Florida. When she isn’t busy planning lessons and activities for her students, Jane is catching up with friends, chasing her dogs around, or relaxing with a good book. Her health is one of her top priorities, so she is mindful of keeping up with her annual doctor appointments. This year, her primary care physician diagnosed her with hypertension after seeing the log of blood pressure readings Jane has kept. Let's review Jane Doe’s case.
Jane Doe has been taking her blood pressure regularly for 3 years at the instruction of her primary care provider when she noticed it rising.
Her doctor decided to refer her to nephrology since the original medications did not seem to be working. Ms. Doe met with Dr. Munjal who made a small, simple change in her medications. Dr. Munjal decreased her blood pressure medication and now her readings are in the 150s and the uncomfortable symptoms of “low” blood pressure have been minimized. Once these symptoms went away, her regiment was changed again to further lower the readings. The uncomfortable symptoms came back briefly, but soon went away as her body acclimated to having lower blood pressure again. Her new goal is 130-140 for her systolic readings. Dr. Munjal explained: “When someone has hypertension, the body can acclimate over time and not experience symptoms of hypertension. This means that when we try to bring the blood pressure back down to a lower range, you may not feel as great as the readings may look. It is important to keep this in mind when working to reach blood pressure goals. When we set a goal, we know that this may take a while to reach since changing blood pressure has to be done in steps. You may feel worse before you feel better.” Working with blood pressure readings is not a sprint, it is a marathon. We must pace ourselves as we work through the steps needed to safely get the blood pressure down to a manageable range. If you have questions or concerns about your blood pressure, call to schedule an appointment with Dr. Munjal! |
