Hypertension is otherwise known as high blood pressure.  Hypertension is the second most common cause of chronic kidney disease in the USA.   It is also very common for people who develop chronic kidney disease for other reasons to also develop high blood pressure related to CKD.  Needless to say, blood pressure is a huge component of my discussions with patients who are trying to stay off dialysis. 

If you have chronic kidney disease and high blood pressure, one of the most important factors that affects your prognosis is how well your blood pressure is controlled.  Said another way, the better your blood pressure is controlled, the less likely it is that you will have to start dialysis.  

I tell my patients to check their blood pressure about 3 times a week — more than that and you will drive yourself crazy and even make your blood pressure go up worrying about your blood pressure!  When you check your blood pressure, it should be done in a seated position with your feet on the floor, relaxed for about 5 minutes (don’t read about politics or watch cable news!).   I know your blood pressure might be elevated when you’re stressed out or exerting yourself, but that’s ok — the medical studies were done on patients seated in a chair with their feet on the floor doing something relaxing for 5 minutes, so that is how we should measure blood pressure. 

Your target blood pressure should be less than 130/80 — and, much different than doctors used to think in years past, I worry about the top number more than the bottom.   Also, 130/80 is your target average blood pressure – everyone’s blood pressure fluctuates significantly throughout the day so that most people will have some high numbers here and there.   And try not to worry too much – in the moment that your blood pressure is high, your brain isn’t just going to “pop.”  The damage done by blood pressure occurs over years, not minutes. 

That said, if you do have very high blood pressure and you have symptoms of headache, chest pain, visual changes, or shortness of breath, or even weird neurologic symptoms like numbness or weakness, that is an emergency, and you should call 911.

A couple of other issues related to the blood pressure numbers:  your blood pressure can be too low.   If you are dizzy when you stand up and just sleepy and fatigued all the time, and your blood pressure is closer to 100 on the top number or lower, that is probably too low and you should discuss with your physician.  That said, sometimes, as you are starting treatment with medication, it takes your body a while to get used to being at or closer to normal blood pressure.  In these cases, you may need to “press on” until your body adjusts to living at a lower blood pressure when that lower blood pressure is normal. 

Diet:

The biggest issue with your blood pressure and your diet is SALT.  Salt is such a huge part of the American diet that many of us think we can’t live without it, much less eat without it.  Americans eat HUGE amounts of salt on everything.  I have heard many say that they “just can’t eat” eggs, tomatoes, potatoes, corn, or anything else without salt.  Well, all of those things can be eaten without salt, and frankly, I enjoy them very much without salt. 

I would recommend removing the saltshaker from your table – that would eliminate, on average, 25% of the salt you would eat if you are an average American.  The other 75% of the salt that most of us eat is in the food before it reaches our table.  It is found in any restaurant food (there are very few low salt restaurants that can keep their doors open), any processed or pre-prepared foods, and obviously fast food and fried food.   (side note:  I think fast food and fried food are poison). 

As with so many things, this is easier said than done, but I would definitely suggest, in addition to restricting salt, just eating a “healthy diet” high in fresh fruits and vegetables and lean non-fried-meats, and relatively low in carbs and dairy products. 

Medications:

There are many different classes of medications that are used for blood pressure and I will go into a few of these: 

Diuretics: 

Diuretics have been a mainstay of blood pressure therapy for many years, and they remain a very important part of blood pressure therapy.  These diuretics are not the kinds of diuretics that dehydrate you or make you urinate an enormous amount — rather than “water pills,” they should be thought of as “salt pills.”  They make your kidneys leave more salt in your urine, depleting your body of salt — and that is how they help your blood pressure.  The main ones used for blood pressure are hydrochlorothiazide and chlorthalidone (which can cause low potassium) and spironolactone and eplerenone (which can cause high potassium).   There are other side effects associated with each of these that you should discuss with your doctor, but excessive urination is really not one of them. 

ACE Inhibitors and Angiotensin Receptor Blockers (ARB’s):

These two classes of medicines work in very similar fashion to block a hormone that would constrict or tighten blood vessels.  The names of ACE inhibitors always end in “pril” like lisinopril or enalapril.   The ARB’s always end in “sartan” like losartan or telmisartan.   These medicines have an enormous benefit for patients with chronic kidney disease because they have been shown to help patients avoid or delay dialysis above and beyond their benefits related to blood pressure control.  At any level of chronic kidney disease, they can be beneficial.  That said, in some patients, they can cause the kidney function to drop too much in the short term or cause high potassium levels severely enough that they cannot be used.  Ask your doctor if this class of medicine would be right for you.  Also note that if you eat a high salt diet, these medicines won’t work to help your blood pressure or your kidneys. 

 Beta Blockers:

These medicines are very commonly used for blood pressure control as well, and all of these drugs end with the letter “lol” as in carvedilol, labetalol, bisoprolol, and metoprolol.  They are very good for blood pressure in general, and side effects include low heart rate and fatigue.  While they don’t have additional benefits for your kidneys above controlling blood pressure, they can be very helpful for those with heart disease.  If your chronic kidney disease is advanced or severe, atenolol in particular should be avoided.  As always, consult with your doctor. 

Calcium Channel Blockers:

These medicines are generally well-tolerated and work well to help control blood pressure, but they don’t have any added benefits to kidneys or hearts.  They include medicines like amlodipine and nifedipine.  Sometimes, people can develops ankle swelling because of these meds.  I have many patients on these medicines. 

There are numerous other classes of medicines that are used for blood pressure control, but those 4 are the mainstays of what we use in nephrology.  If you have any questions, consult with your physician. 

As always, these are general suggestions that may not apply to everyone, so please consult directly with your doctor.

Alabama ranks first in the number of dialysis patients per capita in the United States, and over 1,000 Alabama residents are currently waiting for a kidney transplant. The Alabama Kidney Foundation provides education, support services, and financial assistance to low-income kidney dialysis patients. The foundation also offers statewide education to promote organ donation awareness and the prevention of kidney disease.

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