Retinal detachment and hypertension... dog...

RE: Retinal detachment and hypertension... dog...

Beats — Fri, 03 Jan 2020 19:22:59 GMT

Follow-up:

miscommunication had meant that at follow-up a week after my supposed dose increase, dose hadn't actually increased. Retinae however had partially re-attached. BP was 200mmHg and this time acutally increased dose to 2.5mg benazepril q24hrs and 1.25mg amlodipine q12hrs. BP came down to 160mmHg and retinae totally reattached and saw today and is visual.

Unfortunately is also showing signs of significant systemic disease that won't be investigated. Month ago was noted to be polydipsic, but that has not returned to normal. Has very pale mucous membranes noted for last month now and is in thin body condition having previously lost some weight. Appetite and form remained fine.

RE: Retinal detachment and hypertension... dog...

David Mills — Sat, 16 Nov 2019 10:00:48 GMT

General approach:

Dogs ACEi then amldopine then beta blockers depending on response

Cats Amlodooine then ACEi then beta blockers.

I think it's generally accepted ACEi are better first line in dogs.

RE: Retinal detachment and hypertension... dog...

Beats — Fri, 15 Nov 2019 21:29:12 GMT

[quote user="Robert Lowe"]hydralazine[/quote]

Thanks for that suggestion.

We'd be talking a quarter of a 25mg tablet q12hrs as starting point in this dog of 8kg I think. Never used it. I assume any of the generics (Mylan, Accord, Advanz) are similar when it comes to splitting into quarters and is no harder than splitting a 5mg amlodipine into quarters?

I think that leaving it a week to recheck the BP was a mistake, and that starting on amlodipine alone was a mistake.

It's not obviously PUPD, so that makes the main "underlying" causes of CKD/cushings much less likely. I'm not sure I'd do much different if it did have CKD just now though anyway.

ACVIM 2017 consensus statement on hypertension at for anyone else interested: https://www-ncbi-nlm-nih-gov.liverpool.idm.oclc.org/pmc/articles/PMC6271319/

RE: Retinal detachment and hypertension... dog...

Robert Lowe — Fri, 15 Nov 2019 13:05:39 GMT

I would consider hydralazine as a short term treatment to reduce blood pressure before switching to amlodipine but ideally would want a more extensive medicine work up for underlying causes.

if you can get the BP under control then there is a reasonable chance the retinas will go back on and some vision will be restored.

RE: Retinal detachment and hypertension... dog...

Anthony Dennison — Fri, 15 Nov 2019 12:35:21 GMT

1) I'm not sure there would be a better initial treatment - started on the initial dose of amlodipine and checked 1 week later as per most guidelines

2)Have you checked bloods to make sure no signs of renal disease?

3) Higher doses of amlodipine as a sole agent (unless renal disease is present)