Hypertension: The Basics

Hypertension and Chronic Kidney Disease: Understanding the Connection

Maria Ayau Turcios, MD

Definition of Hypertension

Hypertension, or high blood pressure, occurs when the pressure in the blood vessels is 130/80 mmHg or higher. Blood pressure consists of two components: systolic blood pressure (SBP) and diastolic blood pressure (DBP).

Systolic Blood Pressure

Systolic blood pressure is the higher value in a blood pressure reading. It represents the maximum pressure in the arteries when the heart contracts and pumps blood into the arterial system.

Diastolic Blood Pressure

Diastolic blood pressure is the lower value in a blood pressure reading. It reflects the minimum pressure in the arteries when the heart is at rest between beats.

We can classify blood pressure into several categories: normal, elevated, hypertension stage 1, and hypertension stage 2.

Categories of Blood Pressure in Adults

BP category	SBP		DBP
Normal	< 120 mm Hg	and	<80 mm Hg
Elevated	120 – 129 mm Hg	and	< 80 mm Hg
Hypertension
Stage 1	130-139 mm Hg	or	80-89 mm Hg
Stage 2	> 140 mm Hg	or	≥90 mm Hg

Causes of Hypertension

Genetic Predisposition

Hypertension is a complex polygenic disorder. Multiple single-nucleotide polymorphisms (DNA mutations) can influence blood pressure control. However, these account for only about 3.5% of blood pressure variability. Future studies are needed to better understand the genetic expressions that affect blood pressure.

Environmental Risk Factors

Overweight and Obesity

There is a strong relationship between body weight and high blood pressure. Overweight and obesity are directly linked to hypertension. The relationship is even stronger when considering the waist-to-hip ratio. Research from the Nurses’ Health Study suggests that obesity may be responsible for about 40% of hypertension. In the Framingham Offspring Study, the estimates were even higher: 78% in men and 65% in women.

Sodium Intake

Sodium intake significantly contributes to the age-related increase in blood pressure. Excessive sodium consumption is associated with an increased risk of stroke and cardiovascular disease. The optimal goal is to consume less than 1500 mg of sodium per day. Most adults should aim for at least a 1000 mg/day reduction.

Physical Fitness

Research shows that individuals who are more physically active tend to have lower blood pressure. They are also less likely to develop hypertension. Even small amounts of exercise can help reduce the chances of developing high blood pressure.

Alcohol Consumption

Limiting alcohol intake is crucial for managing blood pressure. The general recommendation is for men to consume no more than two alcoholic drinks per day and for women, no more than one. Excessive alcohol intake can raise blood pressure, contribute to weight gain, and interfere with the effectiveness of antihypertensive medications. Reducing or moderating alcohol use can lead to significant improvements in cardiovascular health and support overall blood pressure control.

Recommendations:

• Men: ≤ 2 drinks/day

• Women: ≤ 1 drink/day

  
  

Excessive alcohol raises blood pressure and adds empty calories.

How to Measure Your Blood Pressure at Home

Accurate Blood Pressure Measurement Steps:

1. Sit in a chair with your feet on the floor and your back supported for at least 5 minutes.

2. Avoid caffeine, exercise, and smoking for at least 30 minutes before measurement. Ensure your bladder is empty.

3. Use an adequately sized cuff on a bare arm that encircles 80% of the arm. Ensure no fabric intervenes. Support your arm on a desk.

4. Do not talk during the measurement.

   
   

Non-Pharmacological Interventions

DASH Diet

Research from the DASH (Dietary Approaches to Stop Hypertension) trial found that following this specific eating plan can significantly lower blood pressure. This diet emphasizes fruits, vegetables, and reduced-fat dairy products while limiting saturated and overall fat intake. The results showed that people with hypertension experienced substantial improvements in their blood pressure. Their systolic pressure decreased by 11.4 mmHg, and their diastolic pressure fell by 5.5 mmHg. The diet also proved beneficial even for individuals with normal blood pressure levels.

Micro/macronutrient	Goal	Examples
Macronutrients	Increase	Fresh vegetables, fresh fruits, low-fat dairy products, whole grains, fish, nuts, poultry
Sweets	Decrease	Sweets, sugar-sweetened beverages
Fats	Decrease	Red meats, total fat, saturated fat, cholesterol
Micronutrients	Increase	Potassium, magnesium, calcium, protein, fiber

Pharmacological Treatment

Blood pressure category	Blood pressure	Management
Normal	<120/80	Promote healthy lifestyle; reassess blood pressure annually
Elevated	120-129/<80	Promote healthy lifestyle; reassess blood pressure in 3-6 months
Stage 1 HTN	130-139/80-89	No ASVD and 10-year ASCVD risk <10% ·       Lifestyle modification; reassess blood pressure in 3-6 months. If not at goal, consider pharmacotherapy ASVD or 10-year ASCVD risk >10% ·       Treat with lifestyle modification and pharmacotherapy (start with one medication)
Stage 2 HTN	>140/90	Treat with lifestyle modification and pharmacotherapy (typically start with two medications)

References

• Whelton, Paul K., et al. “2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.” Hypertension, vol. 71, no. 6, Nov. 2017, https://doi.org/10.1161/hyp.0000000000000065.

• Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med. 1997; 336: 1117-24.

• Jones DW, Whelton PK, Allen N et al. Management of stage 1 hypertension in adults with a low 10-year risk for cardiovascular disease: Filling a guidance gap. A scientific statement from the American Heart Association. Hypertension. 2021; 77: e58 – e67.

  
  
  
  

Conclusion

Understanding hypertension is crucial for managing chronic kidney disease. By recognizing the causes and implementing effective strategies, individuals can take control of their health. Whether through lifestyle changes or medical treatment, every step counts in the journey toward better health.