(22) High Blood Pressure
Kidney problems
I have had some kidney problems recently and I am worried about now having to be treated for raised BP. What will I be given?
ACE inhibitors and angiotensin II receptor blockers have been shown to reduce death from and progression of kidney disease, so these drugs will be the preferred ones for people like you with raised BP and kidney problems. People with diabetes question above) tend to suffer from kidney problems as an additional complication of their diabetes, so many are treated with ACE inhibitors, as these are more effective in helping to slow down the progression of kidney disease.
I have been told that I have chronic renal failure. What does this mean? I was also told that I am very likely to need BP-lowering drugs. Why, and what are they doing?
Chronic kidney (‘renal’) disease can be classified as being due to a diminished excretory function (improperly filtering toxic waste products from the blood) or leakage of protein from the kidney in the urine. Both forms often occur together. High BP often occurs following these types of kidney problems, because the kidney has a critical role in maintaining blood volume by means of the renin–angiotensin system. The commonest reason for chronic renal failure is as a result of diabetes, but other causes of chronic renal failure do occur.
If blood pressure remains high, end-stage renal disease will follow more swiftly, this requires dialysis. In addition, chronic renal disease also increases your risk of heart attack and stroke. BP treatment has two important benefits. Firstly, it helps to slow down renal failure, reducing the risk of end-stage renal failure and dialysis. Secondly, overall cardiovascular risk is reduced.
To get these benefits, good BP control, often with three or more drugs to reach target BP levels, is required. Paradoxically, treatment with ACE inhibitors and ACE II receptor blockers may cause mild kidney problems. This means that you might be referred to a specialist, if you have chronic kidney disease, for appropriate monitoring of your renal function and tailoring of drug treatment.