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High Blood Pressure And Kidney Disease
High blood pressure (hypertension) is a leading cause of kidney disease and kidney failure (end-stage renal disease). Kidney disease can also cause a type of high blood pressure called renal hypertension.
Hypertension can cause damage to the blood vessels and filters in the kidney, making removal of waste from the body difficult. Once a person is diagnosed with end-stage renal disease, dialysis—a blood-cleansing process—or kidney transplantation is necessary.
The symptoms of kidney disease include:
As with high blood pressure, you may not realize that you have kidney disease. Certain laboratory tests can indicate whether your kidneys are eliminating waste products properly. These tests include serum creatinine and blood urea nitrogen; elevated levels of either can indicate kidney damage. Proteinuria, an excess of protein in the urine, is also a sign of kidney disease.
Kidney disease caused by high blood pressure affects every group and race. However, certain groups are at higher risk, including:
To prevent kidney damage from high blood pressure:
For patients who have high blood pressure and kidney disease, the most important treatment is to control their blood pressure through lifestyle changes. Drugs can lower blood pressure and protect the kidneys from further damage, especially in people with diabetes. However, treatments need to be individualized.
The most important blood pressure medications to treat renal hypertension include:
Although hypertension is a leading cause of kidney disease, there is a type of hypertension that is actually caused by kidney disease. Renal hypertension, also called renovascular hypertension, is elevated blood pressure caused by kidney disease. It can usually be controlled by the same blood pressure drugs. Some people with renal hypertension can be helped by angioplasty, stenting, or surgery on the blood vessels of the kidney.
Renal hypertension is caused by a narrowing in the arteries that deliver blood to the kidney. One or both kidneys' arteries may be narrowed. This condition is called renal artery stenosis.
When the kidneys receive low blood flow, they act as if the low flow is owing to dehydration, so they respond by releasing hormones that stimulate the body to retain sodium and water. Blood vessels fill with additional fluid, and blood pressure goes up.
The narrowing in one or both renal arteries is most often caused by atherosclerosis (hardening of the arteries). This is the same process that leads to many heart attacks and strokes. A less common cause of the narrowing is fibromuscular dysplasia. This is a condition in which the structure of the renal arteries develops abnormally for unclear reasons.
Renal hypertension usually causes no symptoms. The narrowing in the arteries can't be felt. Unless it's dangerously high, high blood pressure causes no symptoms either. Symptoms of severely elevated blood pressure include:
The vast majority of people with renal hypertension never experience these (or any) symptoms. High blood pressure is dangerous, partly because there are no symptoms, so organ damage can occur slowly without being recognized.
For most people with renal hypertension due to renal artery narrowing, medications can effectively control blood pressure. However, more than one blood pressure drug is often needed.
In some people with renal hypertension due to narrowing of the renal artery, even taking three or more medications every day may not adequately control blood pressure. In these situations, a procedure to improve blood flow to the kidneys may help.
Possible procedures include:
Angioplasty. A doctor threads a catheter through a large artery in the groin and advances it into the renal artery. A balloon is then inflated for a few moments. This widens the artery and improves blood flow.
Stenting. During angioplasty, a wire-mesh stent can be expanded inside the renal artery. The stent stays in place. This keeps the artery open after the balloon is removed. Research, however, has not shown that stenting is more effective than medication for most people with renal hypertension.
Surgery. A surgeon can bypass the narrowed renal artery by sewing a healthy blood vessel next to it. Surgery is generally considered only when angioplasty and stenting are not possible and is only rarely performed.
These procedures are similar to those used to improve blood flow in the heart in people with coronary artery disease.
12 Natural Ways To Lower Your Blood Pressure
In addition to determining whether you need medications, which you should discuss with your doctor, healthy lifestyle choices can make a significant difference in reducing high blood pressure. Try incorporating the following changes and habits into your daily life.
1. Lose Weight if You're OverweightWeight loss is an important part of reducing high blood pressure, especially for people with obesity, as it's a strong risk factor for hypertension. Dr. Mehta says people who are overweight can have between a two- to six-fold increase in risk of developing hypertension.
"With less weight, the heart and arteries do not have to work as hard," says Dr. Desai. "The heart muscle and the muscles in the arteries do not thicken. Thickening can lead to further increases in blood pressure because of reduced give or elasticity of blood vessels."
Talk to your doctor or registered dietitian about a safe weight loss program that will work for you, or consider trying a support app like Noom. "Even modest weight loss in these patients—4 to 10 pounds—is associated with a significant reduction in blood pressure levels," says Dr. Mehta. However, a 2013 study of more than 740 people found long-term reductions in blood pressure only persisted with weight loss exceeding 2% of the person's initial weight .
Change Your Relationship With Food
Noom doesn't follow a "one-diet-fits-all" approach. What you're already eating can likely be adapted to your goals. Start your custom program today.
Take Your Quiz 2. ExerciseRegular exercise not only aids in weight loss, but also helps decrease high blood pressure. A 2016 study found blood pressure decreased in the hours after an exercise session regardless of a person's age, sex and other characteristics . This effect can result in "somewhere between a 10 and 15 mmHg reduction in systolic blood pressure levels," says Dr. Mehta.
Most doctors recommend at least 30 minutes of moderate-intensity aerobic exercise each day. "Aerobic exercise gets the heart rate up in a gradual and consistent fashion, helps to stretch the heart and arteries, and also increases blood flow to the organs," says Dr. Desai.
If you can't do 30 minutes, Dr. Desai recommends at least 15 to 20 minutes a day, five to seven days a week. Some aerobic exercise options include walking, running, swimming, using an elliptical machine, cycling and playing tennis.
3. Decrease Your Salt Intake"Salt is the enemy of high blood pressure," says Dr. Desai. When you eat too much salt, it increases the amount of fluid that enters the bloodstream and arteries from the surrounding tissue, which raises the pressure in the arteries.
While you may not have to remove salt from your diet completely, avoid foods very high in salt like chips, French fries, salted nuts, soups, store-bought salad dressings, processed foods and cheese.
4. Avoid Excess CaffeineDrinking too much coffee or too many energy drinks that contain caffeine isn't recommended for people with high blood pressure. "Caffeine is a form of adrenaline," says Dr. Desai. "It constricts the arteries and raises the heart rate, both of which increase blood pressure."
If you have high blood pressure, ask your doctor whether you need to adjust your morning coffee habit, as Dr. Mehta says high levels of caffeine can worsen blood pressure control. The Food and Drug Administration (FDA) considers the equivalent of four cups of coffee a day (400 milligrams) safe for the general population, but most experts recommend 200 milligrams or less (two cups of coffee) for people with established hypertension, says Dr. Mehta.
5. Drink More WaterStaying hydrated may be an important way to keep your blood pressure reading in a normal range. "When you're dehydrated, the body produces stress hormones to maintain blood flow to organs," says Dr. Desai. This response can increase blood pressure.
Meanwhile, a 2015 study found a link between dehydration and high blood pressure, although more research is needed . Reducing your caffeine intake and drinking water regularly are both effective ways to prevent dehydration.
6. Drink Less AlcoholA large 2019 study conducted by the American College of Cardiology found moderate alcohol consumption, defined as seven to 13 drinks a week, can substantially increase risk of high blood pressure .
Alcohol can increase your body weight, deplete the body of magnesium and potassium, and dehydrate you, according to Dr. Desai. What's more, alcohol increases stress levels, which cause elevated blood pressure over time as well, he says.
7. Try Blood Pressure Support SupplementsA small study in the International Journal of Hypertension found magnesium supplementation can reduce blood pressure in small amounts . Talk to your doctor before taking magnesium supplements, especially if you have kidney disease. You can also safely incorporate high-magnesium foods into your diet. Dr. Desai recommends foods like leafy green vegetables and unsalted almonds.
Beyond magnesium, research in the British Journal of Clinical Pharmacology suggests supplements for blood pressure, such as potassium, L-arginine, vitamin C, cocoa flavonoids, beetroot juice, coenzyme Q10, controlled-release melatonin and aged garlic extract may also help reduce blood pressure .
8. Avoid Processed FoodsA healthy diet plays an important part in reducing high blood pressure, so many doctors recommend reducing consumption of processed foods. Processed foods are often loaded with sodium and saturated fats, two things people with hypertension want to avoid.
"A good rule of thumb is to have multiple colors of food on your plate," says Dr. Desai. He recommends eating more berries, bananas, beets, dark chocolate, kiwis, watermelon, oats, garlic, lentils, pomegranates, cinnamon, unsalted pistachios and fermented foods like yogurt.
9. Reduce Stress Through Meditation and Rest"Chronic stress can lead to chronic elevations in the stress hormones cortisol and adrenaline," says Dr. Desai. "These hormones constrict the arteries and cause weight gain, which further increases blood pressure."
He recommends reducing stress by using breathing exercises, practicing meditation, completing physical exercise, practicing yoga, logging quality sleep, taking breaks throughout the day, spending time in nature, listening to music and eating a balanced diet.
10. Quit Smoking"Smoking leads to constriction of the arteries acutely, and long-term use greatly contributes to the development of high blood pressure," says Dr. Mehta. One study in Hypertension found smoking can cause an immediate but temporary increase in blood pressure . Take the steps you need to quit smoking if you have hypertension.
11. Eat Dark ChocolateSmall amounts of dark chocolate aren't just tasty—they might help lower blood pressure as well. One large 2010 study found people who didn't have hypertension and ate more dark chocolate had lower blood pressure than those who ate less dark chocolate .
Dr. Desai notes the dark chocolate should have high amounts of cocoa—aim for at least 70%—and should be low in sugar. "It's likely that a compound in dark chocolate known as flavonoids releases a substance known as nitric oxide, which relaxes blood vessels," says Dr. Mehta.
12. Try the DASH DietIf you're unsure how to change your diet to lower blood pressure, Dr. Mehta recommends trying the Dietary Approaches to Stop Hypertension (DASH) diet, which he says is "the best studied dietary approach to helping with hypertension." It consists of foods rich in potassium, calcium, magnesium, fiber and protein and low in saturated fat and sodium.
What Is Labile Hypertension?
Your blood pressure regularly rises and falls, but if your blood pressure changes too much within minutes, this may be one of the signs of labile hypertension.
A blood pressure reading has two numbers. The first number represents systolic blood pressure, which indicates the amount of pressure your blood puts on the walls of your arteries when your heart beats. The second number represents diastolic blood pressure, which indicates the amount of pressure your blood puts on the walls of your arteries in between heartbeats.
Abnormalities in either of these readings can lead to a diagnosis of high blood pressure, but the systolic reading is often more important.
Having a high systolic reading puts you at a greater risk for cardiovascular disease over the age of 50. Your blood pressure naturally increases as you age because:
The American Heart Association outlines five stages of blood pressure: normal, elevated, hypertension stage 1, hypertension stage 2, and hypertensive crisis.
Normal blood pressure. A normal blood pressure reading is less than 120/80 mmHg. Here, "mmHg" stands for millimeters of mercury because the traditional blood pressure gauge — called sphygmomanometer — contains mercury used for measurements.
Elevated blood pressure. Elevated blood pressure is indicated by 120 to 129 mmHg systolic and less than 80 mmHg diastolic measurements. If you get either of these readings, your doctor will ask you to manage your blood pressure to prevent worsening your condition.
Hypertension stage 1. If your blood pressure begins to consistently measure between 130 and 139 mmHg systolic or between 80 and 89 mmHg diastolic, you're in hypertension stage 1. Your doctor may recommend a specific diet and certain lifestyle changes to lower your blood pressure. If you have other cardiovascular risk factors, they may also prescribe a blood pressure medication at this stage before it worsens.
Hypertension stage 2. If your blood pressure consistently measures 140/90 mmHg or higher, you're in hypertension stage 2. It's very likely that you'll be prescribed a blood pressure medication at this stage.
Hypertensive crisis. If your blood pressure reading ever exceeds 180/120 mmHg, your life may be in danger. As a precaution, make sure you measure it again in five minutes to see if it has become lower. If it stays still high, you may be in a hypertensive crisis, and you need to seek immediate medical attention.
Hypertensive crisis is typically accompanied by symptoms like:
Unusual, and sometimes unexplained, spikes in your blood pressure — called labile hypertension — may indicate something is wrong with your health.
Diagnosing labile hypertension is very qualitative. This means that this condition cannot be measured on any scale like the stages of hypertension are — there is no minimum number that your blood pressure has to spike and no minimum number of spikes that have to happen. It's diagnosed depending on what your normal blood pressure range is. Signs of labile hypertension include:
Labile hypertension is usually situational. Spikes in your blood pressure happen in response to stressful life situations. Examples include:
High blood pressure is especially concerning if you develop it when you are in your teens or early twenties or you are over the age of 60. While it still requires medical attention, it's more common to develop high blood pressure in your 40s, especially if you have a family history of high blood pressure. Regardless of age, your doctor will try to distinguish between true hypertension and labile hypertension concerns.
Your doctor will pursue a labile hypertension diagnosis by giving you a 24-hour ambulatory blood pressure monitor. If the results show unusual spikes in blood pressure, your doctor will search for the underlying cause.
If your doctor determines that a medication or a lifestyle choice is contributing to your labile hypertension symptoms, they'll ask you to make changes in those to improve your health. They may also prescribe a different medication or suggest that you make changes like:
If you have an underlying medical condition that is causing labile hypertension, your doctor will treat that condition to help control your blood pressure for improved quality of life. Examples of such medical conditions include:
Many times these conditions cause damage before you even realize it's happening. That's why it's important to talk to your doctor about any concerns you have regarding your blood pressure.
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