VIDEO: Managing hypertension in patients with CKD

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You know, hypertension and chronic kidney disease, that's basically like a chicken and egg kind of thing. You know, the hypertension can cause chronic kidney disease or a chronic kidney disease can cause hypertension. And the wicked part of that is that it's a vicious cycle that when you have high blood pressure, it triggers chronic kidney disease again, or vice versa.

But that in and of itself creates more hypertension, which makes the disease worse. So there again, it's like this vicious cycle. And there's a lot of different factors that link that association between chronic kidney disease and hypertension. You know, just extra buildup of stuff that the kidney should normally filter can cause the blood vessels to sort of spasm down a little bit, which elevates the blood pressure. You know, the kidneys also regulate sodium content.

So even if you follow low sodium diet, if your kidneys aren't filtering well enough, then that leads to a buildup of sodium and fluid, and that contributes to hypertension as well. So those two, hypertension and kidney disease are absolutely linked. Now, in terms of managing the blood pressure, you know, one of the mainstays of treatment of blood pressure in patients with chronic kidney disease is use of agents called ACE inhibitors, or angiotensin receptor blockers. So medications like lisinopril, ramipril, quinapril, those are ACE inhibitors, or medications like losartan, valsartan, candesartan, those are your angiotensin receptor blockers. So those act on blocking a substance called angiotensin II, that sort of helps the blood vessels relax a little bit, which then helps the blood pressure.

So those are commonly used in a mainstay of therapy. Another mainstay of therapy is the use of diuretics or water pills. You know, because the patients with chronic kidney disease tend to have a buildup of sodium and water, you know, a lot of our patients need the water pills, you know, to sort of force out that extra sodium and force out that extra water, to sort of decompress the blood vessels and to help the blood pressure. So you know, in our patients who may have high blood pressure and some swelling on the legs and things like that, you know, the use of diuretics is definitely indicated in that situation.

And there's a lot of really great medications out there that also help the blood pressure, you know, in terms of relaxing those blood vessels or even, you know, sort of relaxing the heart muscle a little bit, so you're not squeezing quite as hard so that, you know, pressure isn't quite as elevated. So there's a lot of different ways that you can approach the blood pressure, you know, from a lot of different mechanisms. The blood vessels, the fluid status, the pump, the heart, you know, all of those kind of different things.

All those medications kind of working together to help control the blood pressure. And like I mentioned, controlled blood pressure is key, key, key in our patients with chronic kidney disease, again, regardless of etiology, it could be, like I mentioned, from any cause of chronic kidney disease, autoimmune, diabetes, vascular disease, you name it. All of that can trigger blood pressure. And like we mentioned, you know, blood pressure can definitely exacerbate or worsen that chronic kidney disease. So it's really imperative that we get that blood pressure under control. And like I said, that's probably one of the strongest interventions that we have, regardless of other types of medicines and things like that to sort of prolong the life of the kidneys for as long as possible.