Hemodialysis 101 | Managing Chronic Disease and Watching for High Blood Pressure Risk Factors

In clinical settings, you often hear terms like "hypertensive nephropathy" and "renal hypertension." Although both conditions involve high blood pressure, they are entirely different concepts. Today, let’s explore these terms so that our kidney friends can learn more.

Hypertensive Nephropathy

Hypertensive nephropathy is a form of primary hypertension caused by prolonged poorly controlled high blood pressure. Patients typically show no early symptoms, making it easy to overlook. As the disease progresses, symptoms like edema and persistent proteinuria may appear. Prolonged high blood pressure can cause microvascular changes in the kidneys, leading to various kidney diseases.

Renal Hypertension

Renal hypertension is a type of secondary hypertension caused by substantial kidney damage and renal artery disease. This condition can occur at any stage of chronic kidney disease (CKD). When kidney disease is accompanied by high blood pressure, the hypertension further deteriorates kidney function, which in turn exacerbates blood pressure fluctuations, leading to resistant hypertension. This creates a vicious cycle.

Simply put, to determine if your high blood pressure is hypertensive nephropathy or renal hypertension, consider whether you had hypertension or kidney damage first. However, in many clinical cases, patients seek treatment only after both conditions have developed, making it difficult to distinguish between them.

Treatment Approaches

1. Hypertensive Nephropathy

To manage kidney disease caused by hypertension, blood pressure should be kept within normal ranges to prevent further kidney damage. Medications that protect the kidneys can be used. If kidney function is also compromised, treatment for kidney insufficiency is necessary in addition to blood pressure control.

2. Renal Hypertension

Treatment for renal hypertension may include diuretics, calcium channel blockers, and renin inhibitors, which can yield significant results. For patients with resistant hypertension, a combination of angiotensin-converting enzyme inhibitors or multiple medications may be used. Clinical treatment should aim to reduce proteinuria, protect kidney function, and lower the incidence of cardiovascular events in patients.

Screening for Hidden Hypertension

Elevated blood pressure outside the clinic is common in the Chinese population, including conditions like morning hypertension, nocturnal hypertension, and insufficient nighttime blood pressure decline.

High-risk groups for hidden hypertension should be screened, including males, overweight or obese individuals, smokers, and patients with metabolic syndrome (obesity, high blood sugar, dyslipidemia, hypertension), and CKD patients.

For patients with borderline high clinic blood pressure but significant target organ damage and no other clear cardiovascular risk factors, 24-hour ambulatory blood pressure monitoring should be considered to avoid missed diagnoses.

Ambulatory blood pressure monitoring measures blood pressure throughout the day (including morning and sleep periods), detecting hidden hypertension. Compared to clinic blood pressure, it has higher diagnostic sensitivity and can more accurately predict cardiovascular events and mortality.

Screening Frequency for CKD Patients

According to the 2020 US Preventive Services Task Force adult hypertension screening consensus and the 2021 KDIGO guidelines for hypertension management in CKD patients, it is recommended that all CKD patients undergo blood pressure monitoring:

· If initial screening blood pressure is normal (<130/85 mmHg), measure blood pressure every 3-6 months.

· If initial screening blood pressure is abnormal (>130/85 mmHg), perform additional monitoring outside the clinic (including ambulatory and home blood pressure monitoring) for confirmation, or repeat measurements in the clinic every 1-4 weeks for several times to confirm.

Hypertension is a common and damaging complication of kidney disease. In China, the prevalence of hypertension among CKD patients is 44.2% to 86.1%, increasing with CKD progression. It is a major risk factor for heart failure, myocardial infarction, and stroke.

Kidney patients should pay close attention to hypertension as a risk factor to prevent it from silently harming the body.

In the next issue, we will discuss the causes and countermeasures for itching. We invite kidney patients to bookmark, follow, and share. If you have any suggestions or topics of interest, feel free to leave us a message.

Let’s continue learning about blood purification in the next issue!

References:

1. Tang Xi, et al. Expert recommendations on early screening for chronic kidney disease and its complications in Chinese adults (2023 edition). Chinese Journal of Practical Internal Medicine, 2023, 43(03), 198-205.

2. Luo Chen, et al. Analysis of the correlation between ambulatory blood pressure and renal insufficiency in patients with renal hypertension. Journal of Hunan Normal University (Medical Edition), 2021, 18(06), 199-202.

3. Tian Xiuli. Research progress in the treatment of renal hypertension. Health in Urban and Rural China, 2021, 36(11), 61-63.

4. China Hypertension Alliance "Guidelines for Ambulatory Blood Pressure Monitoring" Committee. 2020 China Ambulatory Blood Pressure Monitoring Guidelines. Chinese Circulation Journal, 2021, 36(04), 313-328.

The above content is for reference only. The platform does not evaluate, endorse, recommend, or guarantee any products and services, nor does it constitute health, diagnostic, or medical advice. The platform does not guarantee the accuracy, scientific validity, or applicability of the content provided by the authors or providers. For any medical conditions, please consult doctors or other professionals.