Hypertension is a common problem for many people with kidney disease. Unfortunately, even after transplantation, the problem with blood pressure does not take care of itself. Here you will learn more about the most important blood pressure medications and considerations in kidney disease.
Your high blood pressure can be either a reason for or a consequence of kidney disease. Below we have compiled a list of medications for high blood pressure, including their effects and side effects. You can use this list to inform yourself about the different drugs and thus keep track of your health yourself.
What exactly is blood pressure?
Blood pressure is the pressure in the blood vessels. Usually, your blood pressure is measured via a cuff on the major arteries of your arms or legs. This is quick and easy and does not hurt at all. As you may know, your blood pressure is always given in two values. The first, usually higher value, is your systolic blood pressure. The systolic blood pressure is the maximum pressure that occurs in the aorta when the heart pumps blood out of the left ventricle.
The second value indicates the minimum pressure that can be measured in the aorta when the heart is not currently pumping blood out of the left ventricle. This value is your diastolic blood pressure. In case you've ever wondered in this context what the mmHg stands for after the measured values: mmHg is the unit of measurement for blood pressure and stands for millimeters of mercury.
What counts as high blood pressure?
If your blood pressure is too high, you will be told you have high blood pressure. In medical terminology, high blood pressure is also often described as hypertension. In kidney disease, high blood pressure is not uncommon. Studies show that high blood pressure can be detected regularly in up to 85% of all people with kidney disease. High blood pressure can be both a cause and a consequence of kidney disease. But cheer up, you are not on your own in this matter. Your medical team will help you to keep your blood pressure in a healthy range through regular medical examinations. You can also find more information on this topic in the Mizu app.
Set the right target
So now you know that it's important to keep your blood pressure in the green zone. But what exactly are considered good blood pressure values? Without kidney disease, blood pressure at rest ideally should not exceed 129 mmHg (systolic) over 84 mmHg (diastolic). If the systolic values are between 130-139 mmHg or the diastolic values are between 85-89 mmHg, you have high-normal blood pressure. We have summarized the different levels of hypertension for you below:
If you have kidney disease, you will usually have different target values during your time on dialysis and after transplantation. You can find more information about this in the blogs in the Mizu app or in a conversation with your medical team.
What can I do about high blood pressure?
But what can you actually do now if your blood pressure is not in the ideal range? At the heart of therapy for high blood pressure is always your lifestyle. A healthy diet, physical activity and weight have a great influence on your blood pressure. In chronic kidney disease or dialysis, the amount of water you drink is an important factor influencing your blood pressure, as your body can no longer regulate your water balance sufficiently. So try to implement all the tips for a healthy lifestyle as best you can. This is not so easy, especially in the beginning. In the Mizu app you will also find many more resources and tools around the most important topics like nutrition, physical activity, etc. Be patient and don't give up! You will see that your efforts will pay off and you will be able to make a big contribution to your health in the long run.
Medicines for hypertension and kidney disease
In addition to your lifestyle, blood pressure medications (if you take them) are moderately involved in regulating your blood pressure. With the many different names, it is not so easy to keep track of medications exist. For this reason, we want to introduce you to the individual groups of drugs for blood pressure control and discuss their side effects.
ACE inhibitors in renal disease
Nowadays, ACE inhibitors or AT1 blockers are often used to treat high blood pressure. In your body exists the so-called renin-angiotensin-aldosterone system (RAAS). The RAAS is a circuit of hormones that regulates fluid balance in your body, thereby controlling blood pressure throughout your body and in the glomeruli, the functional units of your kidneys. With high blood pressure and dialysis, this system is often somewhat out of balance. However, this system can be influenced through medications.
ACE inhibitors block the production of the blood pressure-increasing hormone angiotensin II and thus lower your blood pressure. In addition to high blood pressure, they are often prescribed for heart failure or excessive protein loss through the kidneys.
As with all other medications, your medical team will determine the right dosage for your ACE inhibitors to find the balance between effects and side effects. ACE inhibitors aim to protect your kidney and try to keep it working longer. However, always talk to your healthcare team on a case-by-case basis. If you experience drops in blood pressure, headache, nausea, irritable cough, or impaired hearing or taste, it is important that you contact your healthcare team promptly. If you experience any side effects, your medical team will work with you to try to manage them.
AT1 antagonists in renal disease
Like ACE inhibitors, AT1 antagonists block the action of the hormone angiotensin II. However, this blockade is done in such a way that the hormone's action is blocked at different receptors in your body. Unlike the ACE inhibitors, the formation of the hormone is not suppressed. Their spectrum of action and use is similar to that of ACE inhibitors. In addition to the kidneys, they also protect other organs of the cardiovascular system, such as the heart and the brain.
AT1 antagonists try to protect your kidney and maintain its function for longer. If you experience any side effects associated with taking AT1 antagonists, it is important to contact your medical team promptly. Symptoms such as irritation of the gastrointestinal tract due to intolerances and disturbances of the central nervous system, for example dizziness or concentration disorders, can be triggered by AT1 antagonists.
Betablockers in renal disease
Betablockers are often prescribed in combination with other blood pressure medications. They block the action of stress hormones on the heart and vessels. Newer drugs often work more on the heart and not on the body's blood vessels. Beta-blockers slow the rate of beating and relax the beating force of the heart, reducing blood pressure and thus the work your heart has to do. In this way, these drugs optimize your heart's work and, if successful, reduce the heart's oxygen consumption and have a protective effect on your cardiovascular system. A lower oxygen consumption means that all your heart cells can be supplied with sufficient energy and oxygen.
If you have been prescribed certain calcium channel blockers (e.g. verapimil or diltiazem) together with a beta blocker, you should consult your medical team again, as these two groups of medications can intensify their depressant effect on your pulse. For this reason, it is especially important that you adhere to the prescribed medication schedule. If you experience any side effects, such as cold hands or feet, significantly reduced exercise tolerance or male potency problems, you should consult your medical team immediately. Together, you are sure to find a solution to resolve these symptoms.
Renin inhibitors for kidney disease
Renin is a endogenous hormone produced in the kidney that has the strongest blood pressure-increasing effect. Renin continues to be made by your kidneys even in chronic kidney disease. Renin inhibitors should not be taken with ACE inhibitors or AT1 antagonists, which you have already learned about above. However, they are a possible alternative if these two drugs are not well tolerated.
Their side effects are comparable to those of ACE inhibitors and AT1 antagonists. It varies from person to person which of these drugs are better tolerated. As you see that there are alternatives if you experience severe side effects with one of the drugs. However, it is very important that you inform your medical team in order to treat the symptoms and, if necessary, to change the medication. Your doctor will do everything in his power to find the most suitable medication for you.
Diuretics or water pills for kidney disease
Diuretics are also known as "water pills". They lower blood pressure by flushing out table salt and thus also fluid out of our bodies. This reduces the pressure in your blood vessels, so that blood pressure levels drop. For mild high blood pressure, diuretics alone can have a good effect.
Diuretic-driven fluid flushing increases the production of urine, so you need to go to the bathroom more often. Broadly speaking, there are three types of diuretic tablets that are prescribed to you for your blood pressure: the aldosterone inhibitors, the thiazide diuretics, and the loop diuretics.
Aldosterone inhibitors usually have the least diuretic effect of the three types of water tablets. A common side effect is an increase in your blood potassium level. It is best to discuss this with your doctor.
Thiazide diuretics work in a different part of your kidney (the early distal tubule) and often have the second strongest diuretic effect of the three diuretic tablets. Side effects may include lower blood potassium, magnesium, and sodium levels.
You'll probably see loop diuretics like furosemide a lot. Of the three "water pills" discussed, they are the most powerful. Not only can they lower your blood pressure, but they can also get water out of your legs or on dialysis to maintain or even increase your residual excretion. Side effects can include low potassium levels in your blood and hearing problems. Right before dialysis, you may be advised not to take diuretics. If your residual excretion is less than 100 ml, they lose their effectiveness and are often discontinued.
Calcium channel blocker in renal disease
Calcium channel blockers lower blood pressure by dilating blood vessels, thereby decreasing the resistance of the walls of your blood vessels. If you take too high a dose at the start of treatment, you may experience headaches, palpitations, facial flushing, or water retention in your legs.
As always, if side effects occur, you should contact your medical team. There are different types of calcium channel blockers. Together, you are sure to find a drug with which the side effects are not so noticeable for you..
Combination of active ingredients
In kidney disease, different drug groups are often combined to better control blood pressure. These combination medications contain a mixture of the drug groups mentioned above and often other drug groups that we have not listed here. The combination of different groups has a more intensive effect on your blood pressure.
So you see that different medications can be used to treat high blood pressure. Please do not be afraid of the side effects. Often there are various preparations that achieve the same effect. It is best to contact your doctor about this. Together you will find the combination of medications that is best for you.
