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High Blood Pressure Medicines and Kidney Disease

What is blood pressure?

Your heart pumps approximately 1,900 gallons of blood through the blood vessels in your body every day. Blood pressure is the force of the blood pushing against the walls of the arteries while the heart pumps. The pressure is determined by the force and amount of blood pumped, as well as the size and flexibility of your arteries.

When it’s difficult for blood to flow through your blood vessels, the pressure against the walls of your vessels will increase. This can cause high blood pressure, also known as hypertension. Your blood pressure continually changes according to your level of activity, temperature, emotional state, posture, physical state and from certain medicines.

How is blood pressure measured?

Blood pressure is usually measured while you are seated with your arm resting on a table or hanging at your side. Blood pressure readings are measured in millimeters of mercury (mmHg) and given as two numbers; for example, 110 over 70 (written as 110/70).

  • The top number is the systolic blood pressure reading. It is the pressure in the arteries as the heart beats.
  • The bottom number is the diastolic blood pressure reading. It is the pressure in the arteries between heartbeats.

In healthy adults, the recommended reading is 120 over 80 or lower, written as 120/80.  If your blood pressure is 140/90 mmHg or higher, your blood pressure may be considered high.

Why should you get your blood pressure tested?

High blood pressure can lead to serious health problems. Most people don’t even know if they have high blood pressure because there are usually no symptoms. High blood pressure increases the risk of heart failure, heart attacks, stroke and kidney failure.

What causes high blood pressure?

In most common cases, the specific cause of high blood pressure is unknown. In some cases, high blood pressure can be caused by kidney problems. The kidneys produce an enzyme called renin that helps control blood pressure. If the kidneys are not working as they should, they may release too much renin, which raises blood pressure. High blood pressure can also be caused by abnormalities in the main blood vessel leaving the heart, sleep apnea or narrowing arteries. In women, birth control pills, as well as hormones taken after menopause, can cause high blood pressure. High blood pressure can also be genetic.

How does high blood pressure hurt your kidneys?

High blood pressure makes your heart work harder. It can also damage blood vessels throughout your body. High blood pressure is especially harmful to the tiny blood vessels in your body, such as the ones in your kidneys. If the blood vessels in your kidneys are damaged, your kidneys may not effectively remove wastes and extra fluid from your body. The extra fluid in your blood vessels may then raise your blood pressure even more.

High blood pressure is the second leading causes of kidney failure, also called end stage renal disease (ESRD), in the U.S. People with kidney failure must either receive a kidney transplant or go on dialysis. High blood pressure causes more than 25,000 new cases of kidney failure in the United States each year according to the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC).

How can I prevent high blood pressure from damaging my kidneys?

The National Heart, Lung, and Blood Institute (NHLBI) recommends that people with kidney disease use whatever therapy is necessary, including lifestyle changes and medicine, to keep their blood pressure at or below 130/80.

Also, if your kidneys are not working properly, your doctor may find protein in your urine. This means that your kidneys are filtering out the protein that you need for healthy growth of the body as waste. If you have a lot of protein in your urine, it is recommended that your blood pressure be lowered to a maximum of 125/75.

Does medicine lower blood pressure?

Many people with high blood pressure need medicine to help lower blood pressure, which also helps to slow the progression of kidney disease. Two groups of medicines that lower blood pressure are:

  • Angiotensin-converting enzyme (ACE) inhibitors
    Angiotensin II is a chemical in the body that narrows blood vessels by making the muscles around the blood vessels contract. Angiotensin II is created by a chemical called angiotensin I. ACE inhibitors prevent angiotensin I from creating angiotensin II. This helps the muscles around the blood vessels relax and enlarges the blood vessels, which reduces blood pressure.
  • Angiotensin receptor blockers (ARBs)
    ARBs block angiotensin II from causing the muscles around the blood vessels to contract and make the blood vessels smaller. ARBs protect the blood vessels from the effects of angiotensin II so that blood pressure stays in a safe range.

ACE inhibitors and ARBs lower blood pressure, which also helps to slow kidney damage. Some people may need to take a combination of two or more blood pressure medicines to stay below 130/80.  

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) sponsored the African American Study of Kidney Disease and Hypertension (AASK) in 2003 to find effective ways to prevent high blood pressure and kidney failure in this population. The results showed that ACE inhibitors were better than other drugs at slowing kidney disease in African Americans.

In addition to an ACE inhibitor or an ARB, a diuretic may be useful. Diuretics are called “water pills” because they help increase the amount of urine created and get rid of excess fluid in your body.

What medicines treat high blood pressure?

ACE inhibitors and ARBs are the two main groups of medicines used to treat high blood pressure. However, sometimes other medicines are needed in combination with ACE inhibitors and ARBs to get blood pressure down to a healthy level. The following list shows the major types of commonly used drugs for treating high blood pressure. There are many other types and alternatives that are not included in this list.

 

Type of Drug

Examples

Comments

Diuretics

Chlorthalidone Tablets®, hygroton, furosemide, Lasix®, indapamide, Lozol®

Diuretics rid the body of excess water, helping to lower blood pressure.

Potassium-sparing diuretics

amiloride hydrochloride, Midamor®, spironolactone, Aldactone®

These diuretics prevent potassium loss in the body. They can be prescribed alone or used with another diuretic.

ACE inhibitors

benazepril hydrochloride, Lotensin®, ramipril, ALTACE®, enalapril Vasoctec®, lisinopril, Prinivil®, Zestril®

 

ACE inhibitors are very effective in treating kidney disease, especially if there is a lot of protein in the urine. Blood tests are needed because ACE inhibitors cause high potassium and worsening kidney function in some people. They may cause a skin rash, loss of taste and cough, but very few other side effects.

Beta-blockers

atenolol, Tenormin®,

betaxolol, Kerlone®,

metoprolol succinate, Toprol-XL ®

Beta-blockers reduce the heart rate and the heart’s output of blood. This is a well-tested and proven treatment; however, asthmatics and people with poor circulation cannot use beta-blockers. Some beta-blockers cause insomnia, fatigue, depression and cold hands and feet.

AIIR antagonists

losartan, Cozaar®, irbesartan, AVAPRO®,

valsartan, Diovan®

These drugs can be used if ACE inhibitors cause side effects. Blood tests to monitor for side effects are required.

Alpha-blockers

doxazosin, Cardura®, prazosin hydrochloride, Minipress®

Alpha blockers are useful as a second or third drug to further reduce blood pressure.

Calcium channel blockers

diltiazem, Cardizem CD®, Tiazac®, nifedipine, PROCARDIA®, verapamil, Calan®, Isoptin®,

nisoldipine, Sular®

Calcium channel blockers are added to other therapy to further reduce blood pressure in kidney disease patients. Some may cause a rapid heartbeat, swollen ankles, constipation, headache or dizziness.

Centrally acting drugs

methyldopa, moxonidine

Methyldopa has side effects, but is it is safe during pregnancy.

Are there other ways I can control my blood pressure?

In addition to taking medicine that's prescribed by your physician, the following lifestyle changes may help control blood pressure:

  • Maintain your weight at a level close to normal. Eat fruits, vegetables, grains and low-fat dairy foods.
  • Limit your daily sodium intake. For example, avoid fast food, which is high in salt.
  • Exercise for at least 30 minutes a day.
  • Avoid drinking too much alcohol. For men, two drinks (two 12-ounce servings of beer or two 5-ounce servings of wine or two 1.5-ounce servings of "hard" liquor) a day. For women, one alcoholic beverage per day.
  • Limit caffeine intake.
  • Stop smoking. Smoking raises blood pressure.

Summary

Blood pressure medicines help the kidneys by slowing or stopping the production of angiotensin II, a chemical in the body that causes the muscles around your blood vessels to contract and narrows your blood vessels. Blood pressure medicines help the tiny blood vessels in your kidneys stay relaxed and dilated so that your blood can flow through them easily without damaging them.

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