instruction: hello doctor I am a 57 year old male with polycystic kidney disease my mi is 27 and I am a non smoker my creatine 25 egfr 63 I am currently on 30 my lisinopril 12 my hydrochlorothiazide daily most recently I changed to months ago taking 40 my lisinopril only and noticed be 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 mhg to 165 105 mhg which has maintained for the last seven days and continues what are the possible causes of such a rapid sustained spike
output: 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 be add amlodipine my 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