Hypertension (high blood pressure) is a common feature of renal failure. It appears in most patients at some point as the disease progresses. The reasons for hypertension in almost all patients with chronic kidney disease (in addition to those whose hypertension is their primary disorder) are complex, but have to do with hormones produced by normal kidneys that regulate blood pressure, especially hormones that control sodium balance. In susceptible people, retention of sodium increases blood pressure, and hormones that increase the sodium content of the body tend to be produced in increased amounts. Other hormones may play a role in hypertension as well, including parathyroid hormone and insulin, both of which tend to rise in patients with hypertension. The body tends to pro duce decreased amounts of substances normally released by the kidneys that lower blood pressure. For these many reasons, high blood pressure is a very common feature of kidney failure.
Occasionally people have high blood pressure caused by the narrowing of one or both of the arteries that lead to the kidneys. Many of these patients can be cured surgically, especially if only one kidney is involved.
Because hypertension further damages diseased kidneys, albeit slowly, it is important to control it. There is a rather clear-cut relationship between blood pressure and the rate of progression of kidney failure, at least in certain subgroups (particularly in those with substantial amounts of protein in their urine—for example, more than 4 g per day.) People with diabetes and kidney disease progress more rapidly if their systolic blood pressure is high; diastolic blood pressure is a weaker predictor. Reduction of systolic blood pressure by giving an angiotensin receptor blocker slows disease progression.
High blood pressure can be treated, either by lifestyle changes such as diet, exercise, and smoking cessation, or, if necessary, by drugs. Diet changes that are particularly effective in lowering blood pressure include restricting your consumption of calories and salt, eating more vegetables and fruits, and reading food labels closely so as to limit intake of sodium and of saturated fats.
First, you may need to lose weight. "Ideal" body weights for men and women of varying heights and frame size are available elsewhere. (For example, see Appendix 9 of Nutritional Management; for the full citation, see Appendix 1 of this book.) To determine your frame size, measure your wrist circumference by placing a soft measuring tape around the smallest part of the wrist. The ratio of your height to your wrist circumference (in inches or whatever units you prefer) is an index of your frame size. Use this table to see if your frame is small, medium, or large.
Frame Men Women
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