Controlling Blood Pressure for Kidney Health

High blood pressure, or hypertension, is the second leading cause of kidney failure, according to the National Kidney Foundation. Although it often does not have any symptoms, hypertension is very common, affecting nearly half of adults in the United States.

When blood pressure is consistently elevated, or uncontrolled, it leads to thickening of blood vessels throughout the body. Over time, this restricts blood flow to many organs, including the kidneys, and can lead to permanent kidney damage referred to as chronic kidney disease (CKD) or end-stage kidney disease (ESKD). For this reason, controlling blood pressure is essential to preserving kidney function, mitigating the risk of CKD, and slowing disease progression for those who already suffer from kidney disease.

Blood Pressure by the Numbers

Blood pressure is measured in millimeters of mercury (mm Hg) and consists of two readings:

• Systolic pressure: Pressure in the arteries when the heart beats.
• Diastolic pressure: Pressure between beats.

Here’s what the numbers represent:

Source: American Heart Association

Lifestyle Modifications for Blood Pressure Control

Lifestyle adjustments can make a substantial contribution to reducing blood pressure and may delay or reduce the need for medication. The key elements are diet, physical activity, and weight management.

• Diet: The DASH (Dietary Approaches to Stop Hypertension) eating plan and the Mediterranean eating style support kidney and cardiovascular health by focusing on nutrient-dense foods like fruits, vegetables, whole grains, and low-fat dairy. Reducing sodium intake is especially important; excessive sodium can elevate blood pressure and worsen kidney function. Those with kidney or heart disease should eat less than 2300 mg of sodium daily, although less than 1500 mg is ideal.
• Physical activity: Regular exercise, such as 20 to 30 minutes per day of moderate-intensity activity (e.g., brisk walking, swimming), can significantly reduce blood pressure. Physical activity has many additional health benefits, including improvement of cardiovascular health.
• Weight management: Achieving and maintaining a healthy weight reduces blood pressure, supporting both kidney and heart health. For those who are overweight or obese, weight loss of even a small percentage of total body mass can contribute to measurable blood pressure improvements.

Medical Management: Medications for Blood Pressure Control in CKD

Blood pressure medications may be needed when lifestyle changes alone are insufficient to normalize blood pressure. Although there are many classes of blood pressure medications, there are two medication classes often used in CKD because they help slow progression of CKD. These include:

• Angiotensin-converting enzyme inhibitors (ACEIs)
• Angiotensin II receptor blockers (ARBs)

In addition to slowing CKD progression, ACEIs and ARBs can also protect the heart and reduce the risk of stroke. Below is a list of commonly prescribed ACEIs and ARBs.

Adherence to prescribed blood pressure medications is critical, as irregular usage can lead to uncontrolled hypertension. Regular follow-up with a healthcare provider is also recommended to monitor effectiveness and make any necessary adjustments. Healthmap Solutions (Healthmap) offers patients a more in-depth medication guide designed to improve ACEI and ARB adherence.

Blood Pressure Monitoring at Home

Patients who have been diagnosed with high blood pressure may benefit from monitoring their blood pressure at home. Oftentimes, a patient’s blood pressure is unusually high (or low) when they go to visit their doctor. Their provider may ask them to keep a log of home blood pressure readings and bring it to their appointments; a blood pressure log can help the provider make a more informed decision about whether to adjust the patient’s blood pressure treatment regimen. For accurate blood pressure readings, patients should:

• Use a clinically approved monitor: Usually, a cuff that measures blood pressure over the upper arm is preferred to a wrist cuff. Healthcare providers can help patients select the appropriate device and advise on frequency of monitoring.
• Maintain a record: Healthmap offers a printable log sheet to help patients keep track of their blood pressure readings.

Long-term Kidney Health and Preventive Measures

Proactive blood pressure control is one of the most effective preventive steps for long-term kidney health. Additional preventive measures include:

• Hydration: Sufficient water intake supports kidney filtration. While daily hydration needs vary, around 6 to 8 glasses of water is generally recommended unless otherwise directed.
• Smoking cessation: Smoking raises blood pressure and heightens the risk of kidney disease. Avoiding or quitting smoking can benefit both kidney and cardiovascular health.
• Limiting alcohol consumption: Excessive alcohol intake can elevate blood pressure. Limiting or abstaining from alcohol is recommended to maintain blood pressure control.

The Role of Healthcare Providers in Blood Pressure Control

Close collaboration with healthcare providers is integral to effective blood pressure and kidney health management. Routine check-ups allow healthcare providers to monitor both blood pressure and kidney function, using diagnostic tests to detect early signs of kidney strain and adjust treatment as needed. Healthmap offers care coordination resources designed to connect patients with the tools needed to support kidney health and manage hypertension.

Conclusion

Managing blood pressure is a vital strategy for protecting kidney health. Through a combination of lifestyle modifications, medical management, and ongoing support from healthcare providers, individuals can reduce their risk of kidney disease or, for those already diagnosed, slow its progression.

At Healthmap, we have made effective blood pressure management and the treatment of associated conditions an integral component of our Kidney Population Health Management program. By helping patients manage their high blood pressure, along with all other comorbidities, we effectively slow kidney disease progression and improve health outcomes for patients with kidney disease. For more information on blood pressure management, download our patient resource, “Managing High Blood Pressure.”