Hypertension, also known as high blood pressure, is a common health condition affecting millions of people worldwide. According to the World Health Organization (WHO), approximately 1.13 billion people worldwide suffer from hypertension, and it is one of the leading causes of cardiovascular diseases, such as heart attack and stroke. Hypertension can also have a severe impact on the kidneys, leading to kidney disease and ultimately, kidney failure. In this article, we will discuss hypertension, its impact on the kidneys, and how it can be managed.

What is Hypertension?

Blood pressure is the force of blood pushing against the walls of arteries as the heart pumps blood throughout the body. Hypertension is a condition where the force of blood against the walls of arteries is consistently too high, leading to potential damage to the arteries and other organs, including the kidneys.

There are two types of hypertension: primary (essential) hypertension and secondary hypertension. Primary hypertension is the most common type of hypertension, accounting for 90-95% of all cases. Its cause is unknown, but risk factors include family history, age, race, obesity, lack of physical activity, and a diet high in sodium. Secondary hypertension, on the other hand, is caused by an underlying condition, such as kidney disease, obstructive sleep apnea, or adrenal gland disorders.

How Does Hypertension Affect the Kidneys?

The kidneys are essential organs that filter waste and excess fluids from the body. In addition, they play important role in production of red blood cells and in bone health. High blood pressure can put additional strain on the delicate blood vessels in the kidneys, leading to damage and reduced kidney function. The kidneys' blood vessels are responsible for filtering blood and removing waste products, but high blood pressure can cause these blood vessels to become narrower, which reduces blood flow to the kidneys. As a result, the kidneys may not function correctly, leading to a condition called kidney disease.

Kidney disease is a severe condition that can progress to kidney failure if left untreated. When the kidneys fail, they can no longer filter waste and fluids from the body, leading to a buildup of toxins in the bloodstream. Kidney failure is a life-threatening condition that requires dialysis or a kidney transplant.

Early kidney disease caused by hypertension is usually asymptomatic and can only be detected during physical examination and/or laboratory tests. Early signs includes needing more medicines to control blood pressure and increased frequency of urination at night. Swelling of the ankles, although common, is usually a late sign. Hypertension can lead to proteinuria, a condition where protein leaks into the urine, which is an early sign of kidney damage even before the blood tests become abnormal. For that reason, it is important to have urine tests during annual physical examination if one has hypertension.

Managing Hypertension to Protect Kidney Health

The good news is that hypertension can be managed to protect kidney health. The first step is to identify and diagnose hypertension through regular blood pressure checks. If diagnosed with hypertension, the healthcare provider may prescribe lifestyle changes and medication to lower blood pressure as appropriate.

There are several classes of medications that can be used to manage hypertension, including:

• Angiotensin-converting enzyme (ACE) inhibitors: These medications relax blood vessels, making it easier for blood to flow through them, and are often prescribed for people with kidney disease, especially if one has proteinuria.
• Angiotensin receptor blockers (ARBs): These drugs also help in dilating blood vessels and are frequently recommended for individuals with kidney disease who are unable to tolerate ACE inhibitors. Be aware that although ARBs are widely prescribed, some of them were recalled by the FDA due to the potential risk of excessive exposure to nitrosamines, which are carcinogenic chemicals. For further information, view this video from the FDA. Consult your physician for guidance.
• Beta blockers: These medications reduce the blood pressure and the heart rate. These are essential medications to reduce the risk of heart attacks among those who have had one heart attack already or if they have had blockages or stents in the arteries of the heart.
• Calcium channel blockers: These medications help to relax blood vessels and are often prescribed to people with kidney disease who have diabetes or heart disease.
• Diuretics: These medications help to reduce the amount of salt and fluid in the body, reducing the strain on blood vessels.
• Mineralocorticoid receptor antagonists (MRAs): These are special category of diuretics that have some protective effect on the kidneys and the heart.

You can learn more about common blood pressure medications in our article "Blood Pressure Medications" and watch the live Q&A here.

Lifestyle modifications are also essential in managing hypertension. These include:

• Eating a Healthy Diet: A diet low in sodium and rich in fruits, vegetables, and whole grains can help. Plant dominant diets such as ‘DASH diet’ and 'Mediterranean diet' have been tested in trials and help people with hypertension.
• Engaging in Regular Physical Activity: Physical activity, such as walking, jogging, or swimming, can help to lower blood pressure and reduce the risk of heart disease and kidney disease. Tracking these activities is a great way to stay on top of your fitness goals.
• Yoga and meditation: If done regularly, yoga and meditation has been shown to reduce high blood pressure and is recommended by the American Heart Association.
• Maintaining a Healthy Weight: Being overweight or obese can increase the risk of hypertension, heart disease, and kidney disease. Losing weight can help to lower blood pressure and improve overall health. Avoiding sodas and sugar rich food items is an important step in weight management.
• Quitting Smoking: Smoking can damage blood vessels and increase the risk of hypertension, heart disease, and kidney disease. Quitting smoking can help to lower blood pressure and reduce the risk of these conditions.
• Prioritize Quality Sleep: Ensure you are getting enough sleep every night. Lack of sleep or poor quality sleep can negatively impact your blood pressure and overall health. Try to maintain regular sleep hours and create a restful environment to promote quality sleep. If you struggle with insomnia or sleep apnea, seek medical advice.

In addition to medication and lifestyle modifications, healthcare providers may also recommend regular kidney function tests to monitor kidney health. If kidney disease is detected, additional treatments may be necessary to slow its progression and prevent kidney failure.

Conclusion

Hypertension is a common health condition that can have a severe impact on kidney health. High blood pressure can damage the delicate blood vessels in the kidneys, leading to kidney disease and ultimately, kidney failure. However, hypertension can be managed through medication, lifestyle modifications, and regular kidney function tests to protect kidney health. In addition to reducing the blood pressure independently, lifestyle changes also help the medications work better. If you have hypertension, it is essential to work with your healthcare provider to develop a treatment plan that is right for you. By managing hypertension and protecting kidney health, you can reduce the risk of serious complications and improve your overall health and well-being.