A Brief Analysis Of The Relationship Between High Blood Pressure And Kidney Disease

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High blood pressure and kidney disease, these two seemingly unrelated diseases, are actually a pair of difficult brothers. Poor control of high blood pressure can cause or aggravate kidney damage, and most of the kidneys will develop uncontrollable high blood pressure at a certain stage. However, many people do not fully understand the relationship between the two, and even patients with high blood pressure or chronic kidney disease may not fully recognize the close connection between the two. Hypertension is already one of the most common causes of end-stage renal disease, which deserves great attention, especially for those who already suffer from hypertension.

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Kidneys and blood pressure are closely related

Hypertension and kidney disease are both common diseases. Among adults in my country, the incidence of hypertension exceeds 20%, and the incidence increases with age. Kidney disease is also a high incidence, and the incidence in adults is also as high as 10%. Hypertension and kidney disease are two diseases that can aggravate each other, and the health of Chinese people is under threat from these two diseases.

Let's first understand how kidney disease can cause high blood pressure.

Patients with acute or chronic kidney disease also have significantly increased rates of hypertension. The main physiological function of the kidneys is to regulate the balance of water, salt and acid base. When kidney disease occurs, the kidneys cannot fully excrete water and salt from the body, resulting in water and sodium retention, resulting in high blood pressure. In addition, the kidneys of normal people can also secrete a hormone called renin. The kidneys of patients with kidney disease secrete renin significantly. The relationship between renin and high blood pressure is very large. It can promote the level of angiotensin II. The latter can stimulate the secretion of aldosterone. Angiotensin II has a strong effect on constricting blood vessels. After the blood vessels become thinner, the resistance increases and blood pressure rises. In addition, aldosterone further promotes water and sodium retention and further aggravates hypertension. . High blood pressure caused by kidney disease is often more difficult to control. Some scholars have found that high blood pressure in chronic kidney disease often requires the combined application of more than 3 drugs to control blood pressure to an ideal range. It can be seen that high blood pressure caused by kidney disease is quite stubborn!

The harm of high blood pressure to renal function is huge. At present, high blood pressure is one of the most common causes of renal failure. About one-fifth of uremia is caused by high blood pressure. During the development of chronic kidney disease, hypertension is also an extremely important driving force for aggravating kidney disease. Studies have found that the control of blood pressure in patients with kidney disease is closely related to the degree of deterioration of renal function. Even if the systolic blood pressure is higher than the target value of 10mmHg, the chance of renal failure will increase exponentially after several years. So, for the kidneys, high blood pressure is such a nasty "brother".

Two "whatever" early diagnoses

Whether it is a patient with high blood pressure or kidney disease, the following two "everything" should be emphasized, namely: all patients with kidney disease must regularly monitor blood pressure, and all patients with high blood pressure must regularly check kidney disease. He emphasized that controlling blood pressure is a very important measure to delay kidney disease. In clinical work, it is found that after many patients suffer from high blood pressure, they do not first find out the cause of high blood pressure, but are just eager to lower blood pressure. He said this is a misconception that needs to be corrected. The correct approach is to first identify the cause of high blood pressure and then treat it. Hypertensive patients, especially young or refractory hypertensive patients, must be checked for renal parenchymal disease or renal artery stenosis.

Patients with high blood pressure can know whether there is kidney disease by checking the following three aspects:

1 Check the urine

In addition to urine routine examination, urine microalbumin should also be checked, because in the early stage of hypertensive nephropathy, there is very little proteinuria in urine, and urine routine examination often cannot detect urine protein, but it can detect trace albumin. protein.

2 Check renal function

It mainly includes serum creatinine and blood urea nitrogen, but it must be emphasized that renal function should not be judged solely based on the serum creatinine value. Some people's serum creatinine only exceeds the normal value by a little bit, and even the serum creatinine does not exceed the normal value. Kidney function may have decreased significantly.

3 Check kidney ultrasound

Ultrasonography can detect kidney size, echo, whether there is a mass or urinary tract obstruction, etc. In addition, color Doppler ultrasonography can also be used to detect whether there is renal artery stenosis. For patients with a thick subcutaneous fat layer, color Doppler ultrasonography is not effective in examining renal arteries. For patients suspected of hypertension caused by renal artery stenosis, renal artery MRI can be selected. This method shows the renal artery very clearly. If the renal artery is still not clear, renal angiography can be done if necessary.

Renal artery stenosis is a relatively overlooked condition that can lead to high blood pressure, often to a more severe degree. Renal artery stenosis is not limited to the elderly, young people can also suffer from renal artery stenosis, but the causes of stenosis vary. For patients whose blood pressure is usually well controlled, but blood pressure has recently increased significantly, special attention should be paid to renal artery stenosis. Once renal artery stenosis is treated in a timely and appropriate manner, it often has miraculous effects. After the arterial stenosis is relieved by the placement of stents in the renal artery, the originally severely increased blood pressure will drop significantly.

Tighter blood pressure targets kidney disease patients

The blood pressure target in renal patients is more stringent than in hypertensive patients without renal disease. For hypertensive patients without kidney disease, it is generally enough to control the blood pressure at 90/140mmHg, but for hypertensive patients with kidney disease, it is generally necessary to reduce the blood pressure to below 130/80mmHg. The higher the blood pressure, the greater the damage to the kidneys.

For patients with both high blood pressure and kidney disease, the choice of antihypertensive drugs is very particular. In principle, drugs that can both lower blood pressure and protect the kidneys should be selected. Such drugs are mainly renin-angiotensin-aldosterone system blockers (two types of drugs with "Sartan" and "Puri") These drugs have the functions of lowering blood pressure, reducing proteinuria, and protecting renal function. For patients without contraindications, such antihypertensive drugs should be the first choice. Another principle for choosing antihypertensive drugs is to choose long-acting antihypertensive drugs. Long-acting antihypertensive drugs can control blood pressure smoothly so that the fluctuation range of blood pressure during the day is small, and the effect of blood pressure fluctuations on the kidneys and heart can even be damaged. More than the increase in blood pressure itself, therefore, it is very important to stabilize blood pressure.

For the side effects of antihypertensive drugs?

At present, most antihypertensive drugs are relatively safe, but various types of antihypertensive drugs have their own shortcomings and side effects. Therefore, it is recommended that you follow up regularly while taking antihypertensive drugs, so as to detect the side effects of the drugs as soon as possible. Correct in time. In conclusion, whether the blood pressure is up to the target has a great influence on the progression of kidney disease. "Achieving blood pressure reduction, stable blood pressure reduction, and selection of antihypertensive drugs that both lower blood pressure and protect the kidneys" are three important principles that should be clarified in the treatment of hypertension in patients with kidney disease.

Lifestyle Changes Beneficial for Blood Pressure Control

In addition to drug treatment for high blood pressure, antihypertensive treatment must start with lifestyle changes. An unhealthy lifestyle is an important factor in inducing or aggravating hypertension. Hypertensive patients should establish a good work and rest time, achieve a reasonable diet and insist on exercising, and quit smoking and limiting alcohol.

High-intensity mental workers are more prone to high blood pressure. However, for hypertensive patients, it is necessary to avoid surprise-style staying up late, continuous intense work, and ensuring adequate sleep time. In addition, patients with high blood pressure should exercise suitable for themselves, and do some relaxing aerobic exercise, but it is not suitable for excessively strenuous exercise.

In addition, patients with hypertension and kidney disease should limit their intake of salt. The occurrence of hypertension is closely related to excessive intake of salt, but unfortunately, the daily intake of salt per capita in my country exceeds The limit is two or three times as much. Excessive intake of salt also has a direct harmful effect on the kidneys. Patients with chronic kidney disease are prone to water and sodium retention, so they should reduce their intake of salt. Generally, the daily intake of salt is recommended to be 3 to 6 grams. People with more serious kidney disease should control it to a lower level.

Hypertension is more common in obese people, so in addition to controlling salt intake, you should also control calorie intake and adopt a low-fat, low-calorie diet. Maintaining a reasonable weight is very beneficial for blood pressure control, especially for those with high diastolic blood pressure who need to pay special attention to weight control and avoid obesity.

For hypertensive patients, it is also very important to establish a good lifestyle and psychological adjustment. It is necessary to avoid the long-term emotional state of nervousness and maintain a relaxed and happy mood. Lifestyle improvements can reduce the use of antihypertensive drugs, so non-pharmacological treatment also plays a vital role in the treatment of hypertension, and its importance should not be ignored.