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How do the kidneys regulate blood pressure?
How to recognize renal hypertension?
Arterial hypertension (persistent increase in blood pressure from 140/90 mm Hg and above) is one of the most common diseases today. At the same time, according to statistics, 25-50% of all cases of hypertension at a young age occurs due to impaired renal function.
How to recognize renal (nephrogenic) hypertension, the readers of "VV" are told by the candidate of medical sciences, the famous Vladimir cardiologist Pavel Novoselsky.
Pavel Albertovich, why does a malfunction of the kidneys affect blood pressure?
- High blood pressure rarely occurs without a reason. In most cases, arterial hypertension is the result of progressive damage to any organ, including the kidneys. It is necessary to identify this body and figure out why it stopped working correctly, and take action.
Things get more complicated when causal relationships are not obvious. Kidney disease is a classic example of how blood pressure can disrupt kidney function, which in turn can increase blood pressure.
As soon as blood pressure drops, the brain sends a signal to narrow the lumen of blood vessels, including the vessels of the kidneys. They respond by releasing renin, a specific substance, into the bloodstream, which is then converted into angiotensin. Angiotensin, by narrowing the blood vessels, stimulates the secretion of aldosterone, a hormone of the adrenal glands that retains sodium and water in the body. It is the renin-angiotensin-aldosterone cascade that triggers a persistent rise in blood pressure.
The inflammatory process in the kidneys is also a signal to the brain. He warns that the kidneys are failing to cope. A protective reaction of the body will also be a narrowing of the vessels of the kidneys and a reduced supply of nutrients to them. If the infection settles for a long time in the urinary system, the brain repeats the same type of actions over and over again, which leads to a stable vascular spasm. The resulting increase in blood pressure impairs renal function. As a result, hypertension is both a cause and a consequence of kidney disease. In such cases, it can be difficult to determine what comes first.
- By the numbers of blood pressure, you can understand that the cause of hypertension was kidney problems?
- In the case of renal hypertension, the lower (diastolic) pressure rises first (90/100 mmHg and above). The upper (systolic) either increases (170 mm Hg and higher), or does not change at all. The difference between their values is sometimes only 20-30 mm Hg. Art.
- What else should you pay attention to if there is a suspicion of renal hypertension?
- Having risen once, high pressure is kept constantly: day and night, under exertion and in a calm state. Even vivid emotions cannot move them.
The thought of diseased kidneys should also be suggested by pain or a feeling of chilliness in the lumbar region; painful or frequent urination and thirst (especially at night); short-term increase in body temperature; poor urine tests (protein, leukocytes, erythrocytes, bacteria in the urine).
- Which specialist should you contact?
- First of all, you need to decide what led to an increase in pressure. During the week, we carry out a daily double (morning and evening) measurement of pressure, carefully enter the data into the self-control diary. We listen to feelings, write down complaints. We turn to the therapist with the self-control diary.
Kidney ultrasound will help to clarify the kidney diagnosis (to identify congenital and acquired kidney anomalies, kidney prolapse) and urine analysis: general analysis (regular urine is taken during the day), Nechiporenko analysis (middle portion of morning urine), microalbuminuria analysis (detects protein at an early stage of kidney damage).
Such an examination is best done annually to keep hypertension under control and not to miss kidney damage, even if it was not detected initially.
- Who is at risk?
- The main victims of renal hypertension are overweight men under the age of 40, as well as women with hypertension during pregnancy and childbirth.
- Why is renal hypertension dangerous?
- A prolonged increase in diastolic pressure quickly leads to renal failure (as a result - a decrease in kidney size, their shrinkage), which, in turn, creating fluid retention in the body, triggers heart failure.
In addition, high blood pressure that does not respond to treatment is fraught with hemorrhages in the retina - up to and including detachment.
It is also worth noting that in narrowed vessels the blood becomes more viscous, plaques settle faster on the walls of arteries that have lost their former elasticity, and clog the lumen. This significantly increases the likelihood of developing a heart attack / stroke at a young age.
- What to save: blood vessels or kidneys?
- Both vessels and kidneys. If the fault of the kidneys in the increase in blood pressure is proven, they should be treated while taking medications for blood pressure. It often happens: the inflammatory process in the urinary system was stopped (at the initial stage of the disease), and the pressure drops significantly, even returns to normal.
If the changes in the kidneys are chronic, the drugs are taken constantly - even when the pressure is normalized. Their reception is aimed at saving blood vessels from overload and returning them to their former elasticity.
Weight loss in such a situation is paramount, it reduces the load on the kidneys and blood vessels. And be sure to limit salt intake as the cause of fluid retention in the body and an increase in the tone of the vascular wall, and with them an increase in blood pressure.
I think it will not be superfluous to remind: the doctor prescribes the pills. It is he who selects groups of drugs that take into account the work of the kidneys and the associated mechanisms of increasing blood pressure.