Hypertension

How Are High Blood Pressure (Hypertension) and Kidney Disease Linked?

The kidneys play an important role in blood pressure (BP) management by regulating salt, water, and certain hormonal levels. Therefore, Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) from any cause can result in high blood pressure. However, severe high blood pressure itself can also cause kidney damage.

Causes

• Genetic predisposition: Family history of hypertension can increase the likelihood of developing the condition.
• Unhealthy lifestyle factors: High salt intake, lack of physical activity, excessive alcohol consumption, and smoking can contribute to hypertension.
• Underlying medical conditions: Obesity, diabetes, kidney disease, sleep apnea, and hormonal abnormalities can lead to hypertension.
• Certain medications: Some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, and decongestants, can elevate blood pressure levels.
• Kidney disease: Certain glomerulonephritic conditions can result in severe high blood pressure. Most patients with CKD from any cause will also have hypertension.

Evaluation and Treatment

Evaluation

Initial evaluation of hypertension includes basic blood and urine tests. Depending on the severity of the BP and the patient’s age, further testing to find an underlying cause of hypertension may be required. This may include:

• Ambulatory blood pressure monitoring
• Ultrasound of the kidneys
• Doppler of the renal arteries
• Heart evaluation, including 2D echocardiography (ECHO)
• Measurement of certain hormone levels in the blood and urine (e.g., serum aldosterone level, plasma renin activity, plasma and urine metanephrines)
• Sleep study

Treatment

• Lifestyle modifications: Adopting a healthy diet rich in fruits, vegetables, whole grains, and low-fat dairy products, along with regular exercise and weight management, can help control hypertension.
• Medications: Various classes of antihypertensive medications, including diuretics, beta-blockers, ACE inhibitors, angiotensin II receptor blockers (ARBs), calcium channel blockers, and others, are prescribed to lower blood pressure.
• Stress management techniques: Practices such as meditation, deep breathing exercises, and yoga can help reduce stress levels, which in turn can lower blood pressure.
• Regular monitoring and follow-up: Routine blood pressure checks and ongoing medical supervision are crucial for managing hypertension effectively.