Hypertension, or high blood pressure, is one of the most common health conditions in India and a major cause of kidney, heart and brain damage. The kidneys both regulate blood pressure and suffer when it stays high. Dr. Satarupa Deb evaluates hypertension from a kidney perspective at Bombay Hospital, South Mumbai.
What Is Hypertension?
Blood pressure is the force of blood against the walls of your arteries. It is recorded as two numbers: systolic (when the heart beats) over diastolic (when the heart rests). Hypertension means that blood pressure remains consistently above the normal range on repeated measurements.
The kidneys play a central role in controlling blood pressure by regulating salt, water and hormones. This is why kidney problems can raise blood pressure, and why uncontrolled blood pressure can damage the kidneys.
Causes and Risk Factors
Most people have primary (essential) hypertension, which develops gradually with no single cause. In some, hypertension is secondary to another condition, and kidney-related causes are among the most common.
- Risk factors: high salt intake, excess weight, physical inactivity, stress, alcohol, smoking, family history and ageing
- Chronic kidney disease and glomerular diseases
- Narrowing of the kidney arteries (renal artery stenosis)
- Hormonal causes such as primary aldosteronism, thyroid disorders or adrenal tumours
- Obstructive sleep apnoea
- Certain medicines, such as painkillers, steroids and some decongestants
Symptoms
Hypertension is often called a silent condition because most people feel perfectly well. It is usually found on a routine check. Very high blood pressure may occasionally cause:
- Headache, particularly at the back of the head
- Blurred vision or dizziness
- Chest pain or breathlessness
- Nosebleeds
- Confusion or weakness, which need emergency care
Diagnosis and Evaluation
Diagnosis requires repeated, correctly measured readings. A nephrologist also looks for kidney causes and for any damage already caused by high blood pressure.
- Clinic readings confirmed with home or 24-hour ambulatory blood pressure monitoring
- Serum creatinine, eGFR, electrolytes and urine albumin
- Kidney ultrasound and, where indicated, Doppler of the kidney arteries
- Hormone tests when secondary hypertension is suspected
- ECG, eye examination and blood sugar and cholesterol tests
Treatment Approach
Treatment combines lifestyle measures with medicines where needed. Reducing salt, eating more vegetables and fruit (unless potassium must be restricted), staying active, keeping a healthy weight, limiting alcohol and stopping smoking can all lower blood pressure.
Many people need one or more medicines. Your doctor will choose these based on your kidney function, urine protein, other conditions and side effects. When a secondary cause is identified, treating it may improve or even resolve the hypertension. Regular follow-up ensures your target is reached and maintained.
When to See a Nephrologist
A nephrologist review is advisable if your blood pressure stays high despite three or more medicines, if hypertension starts at a young age or appears suddenly, if you have abnormal kidney tests or low potassium, or if blood pressure is hard to control during pregnancy planning.
Frequently Asked Questions
What is a normal blood pressure?
Readings below about 120/80 mmHg are generally considered normal. Your personal target may differ depending on your age, kidney function and other conditions, so discuss it with your doctor.
Can I stop my blood pressure tablets once readings are normal?
No. Normal readings on treatment usually mean the medicines are working. Stopping them suddenly may cause blood pressure to rise again. Any change should be made only with your doctor.
Why would a kidney specialist treat high blood pressure?
Because the kidneys regulate blood pressure, nephrologists are trained to find kidney and hormonal causes of hypertension and to manage difficult or resistant cases while protecting kidney function.
How much salt is too much?
Most Indian diets contain much more salt than recommended. Guidelines generally advise keeping sodium intake low, roughly under one level teaspoon of salt a day in total, including hidden salt in packaged foods. Your doctor may advise a specific limit.
Consult Dr. Satarupa Deb
If your blood pressure is high or difficult to control, book a consultation with Dr. Satarupa Deb at Bombay Hospital, South Mumbai, to protect your kidneys and heart.
This page is for general information only and is not a substitute for a medical consultation. Please consult a qualified doctor for diagnosis and treatment.