Blood Pressure on Dialysis: How low is too low?

Like most other folks on dialysis, when I was initially diagnosed with kidney disease, my Blood Pressure (BP) would skyrocket. I was put on a potent cocktail of anti-hypertensives or drugs that would reduce the BP. When I was diagnosed with Left Ventricular Hypertrophy somewhere in late 2005, I was put on Cardivas 6.25 mg twice a day and Ramipril 5 mg once daily. With this my BP nosedived!

I started feeling giddy very often. When I went back to my cardiologist, he said about the BP, "Lower the better!" He did reduce the dose however but the BP would not rise. He asked me not to worry about it. Soon however the giddiness disappeared. It could have been due to something else (dry weight going up, perhaps) or I might have got used to low BPs.

Either way, I continued the drugs because they were good for my heart. Daily nocturnal home hemodialysis also did a world of good to my heart and my Ejection Fraction which had gone down to 30% came back to a healthy 70%!

Coming back to the BP, I often do 80/50 pre-dialysis and 90/60 post dialysis without any symptoms of hypotension. So, I have kind-of got used to low BPs now. I don't have any symptoms purely on account of low BP. When I pull out too much fluid however, I have those symptoms - cramps, giddiness, weakness etc. But not due to my low BP.

I have been a little concerned about this BP though. Is a low BP harmful for my overall health? I have heard from some doctors that they do not take up major surgeries if the BP is too low because of the risk of complications of general anesthesia.

So I talked to my HPS classmate and cardiologist Anuj Kapadia about this. He said that as long as I did not have any symptoms, it was perfectly all right. So, I am going to let this be for now.

The key, I think, is the symptoms. If you are feeling all right, don't do anything about it.