Hypertension
is one of the most common chronic diseases. When many people discover that
their blood pressure has risen, their first reaction is to visit a cardiologist
and take antihypertensive drugs.
However, Professor Chen Wen, Director of the Nephrology Department at Hainan Chengmei Hospital, reminds us that not all hypertension is ordinary essential hypertension. About 5%-10% of hypertension is caused by kidney disease, which is called "renal hypertension". The root cause lies in the kidneys. Treating only the blood pressure without addressing the kidneys will only make the situation worse.
Ordinary hypertension is distinctly different from renal hypertension
Professor Chen Wen explained that many people fail to distinguish between renal hypertension and ordinary hypertension, and the core difference lies in the completely opposite causality.
Common hypertension (essential hypertension): It often occurs in people over 40 years old and is caused by various factors such as genetics, diet, and obesity. If blood pressure is not well controlled for a long time, it will gradually damage the kidneys, which is known as "hypertension damaging the kidneys".
Renal hypertension (secondary hypertension): It occurs when kidney disease precedes the elevation of blood pressure. It is a disorder of the kidney's function in regulating water and sodium metabolism and secreting antihypertensive substances after kidney problems arise, leading to water and sodium retention, vascular contraction, and subsequently hypertension. It belongs to "hypertension caused by kidney disease".
"Renal hypertension tends to affect young and middle-aged people, and even children can be affected. Many patients do not exhibit obvious kidney disease symptoms such as edema and lower back pain in the early stages, and only present with elevated blood pressure, which can easily be treated as ordinary hypertension," said Professor Chen Wen. These patients have poor responses to ordinary antihypertensive drugs, with repeated fluctuations in blood pressure. If kidney problems are neglected for a long time, they can rapidly progress to renal failure and even uremia.
If these conditions occur, seek medical attention from the nephrology department as soon as possible
Professor Chen Wen reminds that renal hypertension has typical characteristics. If a patient with hypertension experiences the following five situations, they must promptly visit the nephrology department for a thorough examination of kidney issues.
Young age of onset: diagnosed with hypertension under the age of 30, with no significant family history of genetic predisposition;
Difficulty in controlling blood pressure: Despite taking 2-3 types of antihypertensive medications, blood pressure remains high or fluctuates significantly;
Accompanying signs of kidney disease: increased foam in urine, hematuria, eyelid/lower limb edema, frequent nocturia, and lower back pain and fatigue;
History of kidney disease: previously suffered from nephritis, kidney stones, polycystic kidney disease, diabetic nephropathy, etc;
Abnormal physical examination results: Renal function tests revealed elevated blood creatinine and blood urea nitrogen levels, while urine routine tests indicated proteinuria and hematuria.
For renal hypertension, treating the kidney is the fundamental approach
"The core of treating renal hypertension is not simply lowering blood pressure, but treating kidney disease first and then precisely controlling blood pressure," Professor Chen Wen clearly stated.
Step 1: Identify the cause and conduct precise examinations. Upon arrival at the nephrology department, urine routine test, renal function test, kidney ultrasound, renal artery ultrasound, and other examinations should be conducted to distinguish between renal parenchymal hypertension (nephritis, polycystic kidney disease, etc.) and renal vascular hypertension (renal artery stenosis). If necessary, renal pathological biopsy should be performed to determine the extent of kidney damage.
Step 2: For kidney disease, treat the root cause. If it is chronic glomerulonephritis, it is necessary to control inflammation and reduce proteinuria; renal artery stenosis can be improved by stent surgery to enhance blood flow; diabetic nephropathy requires strict glucose control to delay kidney damage.
Step 3: Use medication reasonably to protect the kidneys. Professor Chen Wen emphasized that when selecting antihypertensive drugs for patients with renal hypertension, priority must be given to protecting renal function. Clinically, sartans and ACE inhibitors are commonly used, which can not only lower blood pressure but also reduce proteinuria and delay renal damage. For patients with renal insufficiency, it is necessary to avoid using nephrotoxic drugs and combine diuretics to control blood pressure.
In addition, Professor Chen Wen specifically reminded that maintaining a low-salt diet (daily salt intake <5 grams), avoiding staying up late, reducing the intake of high-purine foods, and regularly monitoring blood pressure and renal function are essential. Early detection and intervention are crucial to prevent renal hypertension from progressing to uremia.
Expert Introduction
Chen Wen, Director of Nephrology Department
Chief Physician, Professor, Master's Supervisor
Outstanding experts with prominent contributions in Hainan Province
Leading talents in Hainan Province
Key experts directly connected with the Hainan Provincial Party Committee and Provincial Government
Medical expertise
Skilled in treating primary glomerular disease, IGA nephropathy, lupus nephritis, hypertensive nephropathy, uric acid nephropathy, and diabetic nephropathy; especially proficient in the diagnosis and treatment of critical and complex diseases in nephrology, as well as clinical pathological diagnosis and treatment; proficient in the diagnosis and treatment of indications and complications of hemodialysis and peritoneal dialysis; proficient in the establishment of temporary and long-term vascular dialysis access and peritoneal dialysis access, as well as the management of complications.