Correlation Between Dbp And Kidney Function Decline
Baseline DBP
No linear relation was found between baseline DBP and kidney function decline . The goodness-of-fit test for the adjusted model was not significant in the oldest age stratum . A trend of predicting rapid decline of kidney function was only seen in the highest category of baseline DBP in patients aged 6069years ). The Hosmer-Lemeshow test showed the adjusted model in the oldest patients did not fit the observed data .
Change in DBP
An independent and positive linear relation was found between change in DBP and change in kidney function in all age strata . A decline in DBP predicted rapid decline of kidney function in patients aged 6069 and 7079years and adjusted OR 1.4 , respectively). In the oldest age stratum a trend of higher risk in patients with a decline in DBP was seen , p=0.054 ).
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How Can I Prevent Or Slow The Progression Of Kidney Disease From High Blood Pressure
The best way to slow or prevent kidney disease from high blood pressure is to take steps to lower your blood pressure. These steps include a combination of medicines and lifestyle changes, such as
- being physically active
- managing stress
- following a healthy diet, including less sodium intake
No matter what the cause of your kidney disease, high blood pressure can make your kidneys worse. If you have kidney disease, you should talk with your health care professional about your individual blood pressure goals and how often you should have your blood pressure checked.
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What Medicines May Help Treat Renal Hypertension
If your healthcare provider suspects you might have renal hypertension, you most likely are already on medicines to help control your blood pressure. There are many different types of high blood pressure medications available. Everyone responds to medicine differently. Your healthcare provider will decide which type is best. Remember:
- Many times, more than one type of medicine may be needed.
- The amount and type of medicine may need to be changed from time to time.
- Take all medicines in the exact way your healthcare provider prescribed them.
The goal is to lower your blood pressure. In renal hypertension, two specific types of medications may work better to control your blood pressure:
- Angiotensin-converting enzyme inhibitors.
- Angiotensin receptor blockers .
These medications are rarely prescribed at the same time. In certain cases of renal artery stenosis where both arteries are narrowed, these medications may cause a decrease in kidney function. It is important that your healthcare provider check a blood test for your kidney function one to two weeks after starting or adjusting these medications. In addition to an ACE inhibitor or an ARB, a diuretic, or water pill, may be prescribed to help your kidneys remove extra fluid from the blood. The water pills will make you urinate more often.
Ways To Lower Your Blood Pressure
Here are some steps you may consider taking to help lower your blood pressure:
- Reduce stress: You may need to make changes in the hours you work, your activities, or even your relationships.
- Try slow, deep, rhythmic breathing: You may try meditation, yoga, or other practices that encourage slowing down and taking time to focus on your breathing.
- Prepare healthy snacks in advance: Youll be less likely to reach for processed foods if you already have fruits and veggies cut up.
- Sign-up for an exercise class or running group: Working out with friends can make it more fun and add accountability.
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What Causes Renal Hypertension
Renal hypertension is caused by a part or total bock of the arteries that supply blood to your kidneys. These renal arteries carry blood rich in oxygen and nutrients from your heart to your kidneys. If your kidneys do not get enough blood or oxygen, it may be because these renal arteries are narrowed, a condition called renal artery stenosis.
Atherosclerosis, or hardening of the arteries, is the most common cause of renal artery stenosis. Plaque, made up of fat, cholesterol, calcium and other substances, builds up inside your arteries and causes them to harden and narrow . Plaque can block, either partially or totally, your blood’s flow through an artery in the heart, brain, pelvis, legs, arms or kidneys.
Another cause of renal artery stenosis is fibromuscular dysplasia . While the cause of FMD is not clear, it is different in that it is not caused by plaque build-up, but rather narrowing of your blood vessel walls themselves. FMD is more common in women and should be considered in younger people who develop high blood pressure.
Additional causes include:
- Arteries blocked by grafts.
What Bp Meds Will Cause Gall Bladder Attack
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How Do Doctors Treat High Blood Pressure
First, your doctor may suggest some healthy life changes. This may include:
- Following a low-sodium eating plan
- Being active for at least 30 minutes most days of the week
- Quitting smoking or using tobacco
- Drinking less alcohol
If healthy life changes are not enough to control your blood pressure, your doctor may give you a prescription blood pressure medicine. There are two types of blood pressure medicines that can also help protect your kidneys and slow down kidney disease:
- ACE inhibitors : A group of medicines that lower blood pressure by widening your blood vessels, helping your kidneys get rid of extra water and lowering the levels of hormones that raise blood pressure
- ARBs :A group of medicines that lower blood pressure by widening your blood vessels
Your doctor might also ask you to take a diuretic, also called a water pill. This helps your body get rid of extra fluid which can cause high blood pressure.
Be sure to take all medicines the way your doctor tells you to. Blood pressure medicines work best when you take them every day even if you feel fine.
Talk to your doctor if you have any side effects from your medicines. You may be able to take a different medicine that does not have those side effects.
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How High Blood Pressure Can Damage Kidneys
High blood pressure the second leading cause of CKD is an increase in the force of blood as it flows through your blood vessels. Over time, that force can damage the tiny vessels in the nephrons, just as it can damage blood vessels throughout the body.
The vessels in the kidney are delicate, explains Dr. Leisman. Imagine two hoses: one is high pressure and one is low pressure. Both have water coming out, but the water coming from the high-pressure hose, over time, can lead to damage.
Leisman notes that treating high blood pressure is one of the cornerstones of preventing or slowing kidney damage. In fact, some of the most common drugs used to lower blood pressure are considered a standard treatment for CKD.
Techniques Of Bp Measurement
There are many BP measuring instruments available and each of these has advantages and disadvantages. The instruments available, their use in office and out-of-office setting in clinical practice are shown in Figure 1. Based on the clinical setting, BP measuring techniques can be broadly categorized into the office and out-of-office BP measurements.14,16,17
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Figure 1 BP measurement techniques. |
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Danger Zone Blood Pressure
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How Does High Blood Pressure Affect The Kidneys
High blood pressure can constrict and narrow the blood vessels, which eventually damages and weakens them throughout the body, including in the kidneys. The narrowing reduces blood flow.
If your kidneys blood vessels are damaged, they may no longer work properly. When this happens, the kidneys are not able to remove all wastes and extra fluid from your body. Extra fluid in the blood vessels can raise your blood pressure even more, creating a dangerous cycle, and cause more damage leading to kidney failure.
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Symptoms And Treatments May Vary
Its important to remember that the above-described symptoms and signs of hypertension and kidney disease can vary from person to person. You may not experience any symptoms, but you may also have more than one symptom at the same time. All of that can affect the specific treatment options. Make sure to discuss this with your healthcare team.
Hypertension and kidney disease are frequently addressed with lifestyle changes and medications.
Some lifestyle changes your healthcare professional may suggest include:
- reducing or completely eliminating alcohol use
- quitting smoking
What To Take To Lower Your Blood Pressure
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Effect Of Hypertension Treatment On Outcomes And Treatment Targets
Question 9:
- a)Reduce the risk for death from any cause
- b)Reduce the risk for heart failure
- c)Reduce the risk for CKD progression
- e)Both a) and b)
Question 10:
For the answers to these questions, see the following text.
Additional Readings
- Cheung AK, Rahman M, Reboussin DM, et al. Effects of intensive BP control in CKD. J Am Soc Nephrol. 2017 28:2812-2823. ESSENTIAL READING
- Cushman WC, Evans GW, Byington RP, et al. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010 362:1575-1585. ESSENTIAL READING
- Klahr S, Levey AS, Beck GJ, et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med. 1994 330:877-884.
- Ruggenenti P, Perna A, Loriga G, et al. Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease : multicentre, randomised controlled trial. Lancet. 2005 365:939-946.
- Schrier RW, Abebe KZ, Perrone RD, et al. Blood pressure in early autosomal dominant polycystic kidney disease. N Engl J Med. 2014 371:2255-2266.
- Wright JT Jr, Bakris G, Greene T, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA. 2002 288:2421-2431.
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