High Blood Pressure and Kidney Disease
While most people know that high blood pressure is a leading cause for many adverse conditions such as stroke, heart disease, and possibly dementia, many patients are unaware of the link between elevated blood pressure and kidney disease.
High blood pressure affects 108 million people, or almost 1 in 2 adults in the US. It’s a condition that develops over time and requires long-term treatment to manage effectively. High blood pressure is the second leading cause of kidney failure in the United States. Kidney disease is one of the main outcomes of having high blood pressure over a period of years.
By middle age, many individuals start to develop high blood pressure, requiring treatment. By age 50, many people have high blood pressure, and the numbers increase with age.
Perhaps the most important message is to keep patients under routine care for their hypertension. Many patients miss follow-up visits and may drop out of care. Without routine care, patients run out of medications, so that diabetes and high blood pressure become uncontrolled, leading to faster progression of kidney disease.
Second, while drug therapy is a mainstay, especially for blood pressure control and controlling diabetes, don’t underestimate the benefits of lifestyle changes for patients.
Third, measure blood pressure accurately. Health care providers should follow the recommendations of the Journal of American College of Cardiology Scientific Expert Panelto measure blood pressure in a medical setting with the patient seated, resting quietly with their back supported and feet flat on the floor. Use of validated automated devices reduces much, but not all, of the error associated with manual devices, like aneroid manometers.
Fourth, encourage patients with diabetes to monitor their own blood pressure and blood sugar, and provide training so that patient readings are accurate. This type of physician-patient partnership can make patients happier, more satisfied, and provide motivation to continue with their care.
Age is probably the most important risk factor for all of these conditions. As people age, the risk of high blood pressure, diabetes, and kidney disease, including diabetic kidney disease, increases.
Race and ethnicity are also factors. African Americans have a very high risk of kidney disease, some of which may be related to having the APOL1 gene. However, even African Americans without the gene are at higher risk of developing kidney disease. Native Americans are also at higher risk of kidney disease, but the actual risk level may differ between specific tribes. Certain tribes have a higher risk of kidney disease than others. Hispanics/Latinos also show a higher rate of kidney disease compared to non-Hispanic whites. Many of the differences in kidney disease by race and ethnicity are related to health and health care factors, such as poverty or access to care, as opposed to being directly related to race or ethnicity.
As mentioned previously, as blood pressure rises, so does the risk of chronic kidney disease and diabetic kidney disease. Poor glycemic control and duration of diabetes increase the risks of developing diabetic kidney disease and other complications of diabetes.
Other factors associated with increased risk of developing high blood pressure and chronic kidney disease and/or diabetic kidney disease include
- Quality health care. Lack of health care continuity greatly affects the progression of these conditions.
- Food and beverages. What we eat and drink can directly affect blood pressure and glucose control in people with diabetes.
- Geographic location. The geographic distribution in the United States of high blood pressure, chronic kidney disease, diabetes, and obesity, while not completely overlapping, is highest in the southeastern states, from Virginia through Louisiana. Non-African Americans living in this area also show high rates of these conditions.
- Lower socioeconomic status. Individuals who are poor have a high risk of developing kidney disease. Less access to health care might be one reason.
Encouraging patients to adopt healthier eating habits, increase their exercise and take their blood pressure and diabetes medications as directed will make them partners in their own healthcare and help prevent chronic kidney disease.