New Therapies To Lower Bp In Hypertension
In the last 5 years, several new therapeutic options have become available to improve the management of CKD patients reducing their tendency to develop cardiovascular events and to progress towards ESKD. These new therapies concerned essentially patients with type 2 diabetes and a diabetic nephropathy with the development of inhibitors of sodium-glucose cotransporter 2 or glucagon-like peptide-1 receptor agonists . In patients with type 2 diabetes and kidney disease, both SGLT2-inhibitors and GLP-1-RA demonstrated significant beneficial effects on cardiovascular, mortality, and kidney outcomes.70,71 In patients with type 2 diabetes and stages 3b-4 CKD, dapagliflozin did not decrease HbA1c but decreased albuminuria, BP and body weight to a clinically meaningful extent.72 In large randomized clinical trials, the marked cardiovascular and renal benefits of SGLT2 inhibitors and GLP-1-RA were obtained with relatively modest decreases in BP suggesting other mechanisms of cardiac and renal protection. Nonetheless, SGLT2 inhibitors have been reported to lower BP effectively even on top of RAS blockers or diuretics.73
How Is Renal Hypertension Diagnosed
It is important to see your healthcare provider regularly to make sure your blood pressure numbers are checked and are within the normal range. He or she may recommend blood tests.
A healthcare provider can gather clues that vascular disease may be present by taking a thorough history and performing a physical exam. If you have a history of other vascular diseases, such as heart attacks or strokes, you are at higher risk for having renal artery stenosis. One exam, listening to the neck or belly with a stethoscope, may help identify narrowed arteries. When blood flows through a narrowed artery, it sometimes makes a whooshing sound, called a bruit.
Healthcare providers may order one of the imaging tests below to look for narrowed kidney arteries. However, finding a narrowed kidney artery alone does not mean that your high blood pressure is due to renal hypertension. Many people have narrowing of kidney arteries without high blood pressure or with high blood pressure that is not caused by the narrowing . The healthcare provider will need to use other clinical clues to help determine if the two are connected.
Imaging tests that can be done to see if the kidneys arteries have narrowed include:
How Will I Know Whether I Have High Blood Pressure
Most people with high blood pressure have no symptoms. The only way to know whether your blood pressure is high is to have a health professional measure it with a blood pressure cuff. The result is expressed as two numbers. The top number, which is called the systolic pressure, represents the pressure when your heart is beating. The bottom number, which is called the diastolic pressure, shows the pressure when your heart is resting between beats. Your blood pressure is considered normal if it stays below 120/80 . People with a systolic blood pressure of 120 to 139 or a diastolic blood pressure of 80 to 89 are considered prehypertensive and should adopt health-promoting lifestyle changes to prevent diseases of the heart and blood vessels. If your systolic blood pressure is consistently 140 or higher or your diastolic pressure is 90 or higher, you have high blood pressure and should talk with your doctor about the best ways to lower it.
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How Often Should I See My Doctor
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Your CKD team will outline a treatment plan for you after you are diagnosed. Most patients come to the clinic 1 or 2 times per year. Well ask you to come in more often if:
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You start a new medicine or we change your medicine dose.
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Your kidney function is getting worse.
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Your blood pressure is not controlled.
At each visit, we will test your blood and urine and measure your blood pressure.
DONT be afraid to ask questions. We are here to help you.
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What Are The Symptoms
High blood pressure doesnât usually cause symptoms. Most people donât know they have it until they go to the doctor for some other reason.
Very high blood pressure can cause severe headaches and vision problems. These symptoms can also be caused by dangerously high blood pressure called malignant high blood pressure. It may also be called a hypertensive crisis or hypertensive emergency. Malignant high blood pressure is a medical emergency.
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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.
What Are Kidneys And What Do They Do
The kidneys are two bean-shaped organs, each about the size of a fist. Theyre located just below the rib cage against the back muscles, on the left and right sides of the body.
Kidneys have two very important functions: they help the body pass waste as urine, and they help filter blood before sending it back to the heart. They also:
- Help maintain the balance of minerals and electrolytes in the body, such as calcium, sodium, and potassium
- Play an essential role in the production of red blood cells
- Help maintain the delicate acid-base balance of the blood
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How Is High Blood Pressure Treated
If being more active, eating healthier, and other lifestyle changes are not enough to control your blood pressure, your doctor may tell you to take a blood pressure medicine. There are many types of blood pressure medicines and you may need to take more than one treat your high blood pressure.
There are two types of blood pressure medicines that can also help protect your kidneys and slow down kidney disease:
- ACE inhibitor: angiotensin-converting enzyme inhibitor
- ARB: angiotensin II receptor blocker
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 any medicine the way your doctor tells you to. Blood pressure medicines work best when you take them every day, even if you feel fine. If you have any side effects from your medicines, talk to your doctor. You may be able to take a different medicine that does not have those side effects.
If you have trouble remembering to take your medicines, try to:
- Set an alarm to remind yourself
- Use a pill box to keep your medicines organized
- Take your medicines at the same time every day as part of your normal routine, such as when you brush your teeth or eat a meal
How Does Blood Pressure Affect The Kidneys
Joe Rutkowski, PhD, an assistant professor in the Texas A& M College of Medicine, explains his research on blood pressure and its effect on the kidneys…and vice versa.
Christina Sumners: Welcome to Science Sound Off, Im Christina Sumners.
Tim Schnettler: And Im Tim Schnettler.
Christina Sumners: Our guest today is Dr. Joe Rutkowski, an assistant professor of medical physiology at Texas A& M College of Medicine. Welcome, Dr. Rutkowski.
Joe Rutkowski: Thank you for having me.
Christina Sumners: So you and some of your fellow researchers have recently received a couple of major grants to study the interaction of renal lymphatics and blood pressure. Could you tell me a little bit about what you guys are up to?
Joe Rutkowski: So the lymphatic system is really underappreciated by most in the medical field. Its part, it closes the circulatory loop, and its responsible for the clearance of fluid, macromolecules, and immune cells from peripheral tissues and bringing them back into central circulation. As such, it plays a critical role in inflammation and immunity. And work over the last decade in many labs has identified that hypertension is in part a disease of chronic inflammation in the kidney. And so we hypothesized that changes in the kidneys lymphatic architecture would play a role in regulating blood pressure.
Christina Sumners: So how can high blood pressure affect your kidneys, or does it affect your kidneys in any way?
Tim Schnettler: The lymphatic. Either one.
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Can Medicines Help Control Blood Pressure
Many people need medicine to control high blood pressure. Several effective blood pressure medicines are available. The most common types of blood pressure medicines doctors prescribe are diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers , beta blockers, and calcium channel blockers. Two of these medicines, the ACE inhibitors and ARBs, have an added protective effect on the kidneys. Studies have shown that ACE inhibitors and ARBs reduce proteinuria and slow the progression of kidney damage. Diuretics, also known as “water pills,” help a person urinate and get rid of excess fluid in the body. A combination of two or more blood pressure medicines may be needed to keep blood pressure below 130/80.
How Does Diabetes Lead To Kidney Disease
People with diabetes who have consistently high blood sugar and high blood pressure levels have an increased risk of developing kidney disease. This is because high blood sugar and high blood pressure levels can cause the nephrons in the kidneys to become damaged, and therefore they cannot filter blood and waste products properly.
As some nephrons become damaged, the remaining nephrons have to work harder this increases pressure in these nephrons, which in turn causes them to succumb faster to damage. It becomes a vicious cycle: as more nephrons become destroyed by high glucose and high blood pressure, the pressure within the kidneys, as well as blood pressure, both increase. This causes even more harm to the kidneys.
As the damage and pressure within the kidney increases, two things occur:
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How Does High Blood Pressure Hurt My Kidneys
High blood pressure makes your heart work harder and, over time, can damage blood vessels throughout your body. If the blood vessels in your kidneys are damaged, they may stop removing wastes and extra fluid from your body. The extra fluid in your blood vessels may then raise blood pressure even more. It’s a dangerous cycle. High blood pressure is one of the leading causes of kidney failure, also commonly called end-stage renal disease . People with kidney failure must either receive a kidney transplant or go on dialysis. Every year, high blood pressure causes more than 25,000 new cases of kidney failure in the United States.
How High Blood Pressure Can Damage Your Kidneys
Your heart, the key organ of the circulatory system, constantly pumps blood through your blood vessels. Good blood flow is essential for normal kidney function, and even minor blood flow problems can affect kidney function and increase your risk of serious health problems.
Although a certain amount of force is needed to push blood through the blood vessels, the pressure inside the vessels sometimes becomes too high. High blood pressure can damage the blood vessels that lead to the kidneys, causing them to stiffen or narrow.
As a result, less blood reaches your kidneys, making it difficult for the organs to function properly. Tiny blood vessels inside the kidneys that filter blood may also be damaged.
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Recognizing The Symptoms Of Ckd
CKD doesnt typically cause any symptoms until kidney function has declined substantially, which is why its important to detect the condition well before any symptoms develop.
Part of the reason we have so much difficulty in diagnosing chronic kidney disease early is that people dont usually get symptoms until their kidneys are at maybe 20 or 30 percent function, says Leisman. Before that, The patient feels perfectly fine and might not go to the doctor.
Initial symptoms of CKD after kidney function has declined substantially, but before kidney failure occurs can also be mild or nonspecific. Thats another reason you shouldnt wait until you experience symptoms to get screened for CKD, especially if you have diabetes, high blood pressure, or other risk factors. As kidney function worsens, your symptoms may worsen or you may develop additional symptoms.
Talk to your doctor if you experience symptoms of CKD. If CKD is suspected, your doctor will ask about your medical history and conduct a physical exam. They may also perform tests, such as a blood test to measure the level of waste products in your blood or a urine test to check for protein, to help make a diagnosis.
Role Of Oxidative Stress
The reactive oxygen product hydrogen peroxide is known to be a mediator of cellular injury. Within the kidneys, ROS are produced in arterioles, glomerular and tubular cells, macula densa and podocytes. Vasoactive agents, mechanical factors such as shear stress and metabolic factors stimulate cellular inflammation and ROS production, inducing either NADPH oxidase or mitocondria.
Of interest, recent work from our group has demonstrated that differential modulation of UCP2 occurs in an animal model of hypertension and increased susceptibility to renal vascular damage in the presence of Japanese-style high-salt diet. In fact, in this experimental context, oxidative stress was highly increased in the damaged renal tissue.
Notably, there is evidence that uric acid can stimulate oxidative stress, endothelial dysfunction, inflammation and vasoconstriction, therefore, having a role in the pathogenesis of hypertensive nephropathy. Raising uric acid levels in rats can induce glomerular hypertension and renal disease as noted by the development of arteriolosclerosis, glomerular injury and tubulo-interstitial fibrosis.
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How Diabetes Can Damage Kidneys
Diabetes is the leading cause of CKD: Approximately 1 in 3 people who have diabetes also have kidney disease, according to the Centers for Disease Control and Prevention . People with diabetes often have elevated levels of sugar in the blood, which can cause damage to many tissues in the body over time, including in the kidneys.
The working units of the kidneys, called nephrons, contain networks of tiny blood vessels that filter waste products from the blood.
When sugar is high in the blood, the sugars can bind to different proteins in the nephrons and change the structure of those proteins, says Staci Leisman, MD, a nephrologist and associate professor of medicine and medical education at Icahn School of Medicine at Mount Sinai in New York City. This can make the nephrons less effective at filtering and lead to protein in your urine a key sign of CKD.
Lowering blood sugar levels, which is the number one goal of diabetes management and treatment, can help prevent or slow kidney damage.
Inflammation And The Immune System
Inflammation makes an important contribution to the genesis of hypertension and related target organ damage. Inflammation is associated with increased vascular permeability and release of potent mediators, such as reactive oxygen species, NO, cytokines and metalloproteinases. Cytokines mediate the formation of neo-intima , thereby decreasing the lumen diameter of resistance vessels , and promoting vascular fibrosis, leading to increased vascular resistance and stiffness. Cytokines also affect renal tubular function by increasing local synthesis of angiotensinogen and angiotensin II, as well as promoting sodium and volume retention in hypertension. Matrix metalloproteinases stimulate the degradation of the extracellular matrix, allowing infiltration of immune cells through the vessel wall into the interstitium of the affected organs, promoting apoptosis and enhancing collagen synthesis and matrix deposition, leading to target organ damage.
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Why Care About Htn
If I honestly look back at my life, its pretty clear that up until my enlightenment a few years ago, I was always kind of a here and now guy. I never really focused on how my choices today could affect my tomorrow, my next year, or my next ten years. I have to say, its nice actually thinking about the future now and blood pressure is certainly something that we should focus on today in order to ensure a more content and healthier tomorrow.
After all, having Hypertension can lead to:
- Loss or decreased vision
- Heart Failure
- Stroke
And if we get any of these, they can lead to other things like depression, lack of intimacy and difficulty with our relationships, pain, heart surgery, more medications, fatigue and inability to participate in activities that we want to participate in, and even an inability to speak, eat, or use our arms and legs. Not good.
High Blood Pressure And Chronic Kidney Disease
Blood pressure is the pressure of blood pushing against the walls of your arteries. Arteries carry blood from your heart to other parts of your body.
Blood pressure normally rises and falls throughout the day, but it can damage your heart and cause health problems if it stays high for a long time. Hypertension, also called high blood pressure, is blood pressure that is higher than normal.
Uncontrolled high blood pressure is the second leading cause of kidney failure in the US. Severe high blood pressure can harm kidney function over a relatively short period of time. Even mild forms of high blood pressure can damage kidneys over several years.
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