Download Kidney Disease, High Blood Pressure, and Urine Proteins

FACT SHEET FOR PATIENTS AND FAMILIES
Kidney Disease, High Blood Pressure,
and Urine Proteins
How is high blood pressure
linked to kidney disease?
Normal blood pressure is less than 120 “over” 80 (120/80).
For most people, if the top number (systolic) is more than
140 or the bottom number (diastolic) is more than 90
(140/90), it’s considered high blood pressure (hypertension).
If you have kidney disease, your target will probably be lower
because blood pressure affects the kidneys. Your doctor will
work with you to set a blood pressure goal based on your age
and whether you have certain proteins in your urine. For
most kidney patients, the goal is below about 140/90.
High blood pressure can
cause kidney disease.
High urine proteins is a
sign that your kidneys aren’t
working properly. It can get
worse over time.
Controlling your blood
pressure can reduce urine
proteins. It can also slow the
progress of kidney disease.
You may know that high blood pressure increases your
risk of heart disease, heart attack, or stroke. But high
blood pressure is also linked to your kidneys.
•• High blood pressure is a common cause of kidney
disease — and it can make kidney disease worse over
time. High blood pressure damages the blood vessels in
your kidneys, which keeps them from filtering your
blood correctly.
•• High blood pressure can increase urine proteins.
If the “pipes” in your kidneys are leaking, high blood
pressure puts force on the leaks. This force causes more
protein to pass through — and can make the leaks
themselves worse.
•• Kidney disease can increase your blood pressure.
When your kidneys can’t properly filter the fluids in
your body, your blood pressure rises.
How can I help control high blood
pressure and urine proteins?
How are urine proteins linked to high
blood pressure and kidney disease?
By keeping your blood pressure low, you can reduce the
protein in your urine and slow the progression of kidney
disease. You can do this by following the MAWDS plan:
Your doctor checks proteins in your urine with a urine
test. If you have diabetes, you’ll probably have this test
every year. Or, depending on your stage of kidney disease,
you might need it more often. Urine proteins are linked to
kidney disease and high blood pressure:
•• High urine proteins are a sign of kidney disease.
Healthy kidneys filter waste products into your urine,
but leave protein in your body. If you think of the tiny
tubes in your kidneys as pipes, urine proteins are a sign
that the pipes are leaking. The leaks can increase as
your kidney disease progresses.
•• M - Take prescribed medication as directed.
•• A - Increase your physical activity.
•• W - Lose weight, if you’re overweight.
•• D - Eat a healthy diet that that’s low in sodium (salt).
•• S - Stop smoking and manage stress.
To learn more about all of these, turn the page.
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Manage blood pressure and urine proteins with MAWDS
Learn and remember “MAWDS” to help manage your blood pressure and reduce urine proteins.
Medication — Take your medication.
Taking prescribed medications is extremely
important. Make sure you understand how and
when to take your medications. See page 3 for
information on medications that can lower
blood pressure and urine proteins.
Activity — Stay active every day.
Getting at least 30 minutes of moderate-level
aerobic exercise most days can help you lower
your systolic blood pressure as much as 9 points.
What does “moderate-level aerobic exercise”
mean? Aerobic exercise uses large muscle groups,
and it’s usually continuous and rhythmic.
Examples include biking, brisk walking,
swimming, hiking, dancing, and raking leaves.
At a moderate level, you breathe a little harder,
but aren’t out of breath. Your muscles feel a little
fatigued, but they’re not burning from pain. You
feel invigorated, but not exhausted.
Weight — Maintain a healthy weight.
If you’re overweight, losing even a small amount
of weight can lower your blood pressure. Studies
have shown that if you’re overweight, you can
reduce your systolic blood pressure by 2 to 10
points for every 10 pounds that you lose.
How can you know whether you’re
overweight? A good way to tell is your Body
Mass Index (BMI). The BMI formula compares
your weight to your height. You can find a BMI
calculator at www.nhlbi.nih.gov/guidelines/
obesity/BMI/bmicalc.htm — if your BMI is over
25, you’re overweight. (If you have advanced
kidney disease, you might be underweight. In
this case it’s important not to lose weight.
Check with your healthcare provider.)
The best ways to reach and maintain a healthy
weight are to be active and follow a healthy eating
plan. Intermountain’s Weigh to Health booklet
provides advice and encouragement.
Diet — Eat a healthy diet that’s low in
sodium (salt).
Following a healthy eating plan that limits sodium to
less than 2,000 mg per day can lower your systolic
blood pressure by 2 to 8 points. One study showed
that you may be able to reduce your blood pressure
after just two weeks!
Tips on reducing sodium: First, lose the salt
shaker. But reducing sodium means more than
just not adding salt.
–– Avoid high-sodium foods like canned soups
and sauces, macaroni and cheese, pizza, hot
dogs, salty snacks, potato salad, pickles, and
processed meats (ham, salami, beef jerky).
–– Read food labels carefully. Look for foods
with sodium content less than 5% Daily
Value. Remember to check the serving size;
that’s the basis for the sodium value and other
nutrition facts.
–– Look for “unsalted,” “no salt added,” or
“low-sodium” versions of your favorite
foods. You may be surprised by how many
you can find.
–– When you eat out, ask for condiments and
dressings “on the side.”
Limit salt substitutes. Many salt substitutes are
high in potassium. Potassium is a mineral that can
build up in your blood if you have kidney disease
and lead to other health problems. Instead of salt
substitutes, consider using lemon, herbs, and herb
seasoning mixes (such as Mrs. Dash).
Smoking and Stress — Stop smoking
and manage stress.
Tobacco harms your arteries and increases your
blood pressure. Chronic stress can also take a toll
on your body. Quitting smoking ­— and learning
to manage stress — can lower your blood
pressure and improve your overall health.
Intermountain’s booklet Quitting Tobacco: Your
Journey to Freedom has information and strategies
to help you become tobacco-free for life.
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Taking blood pressure medication
•• Make sure you understand exactly how to take your
medications, including when to take them, how much
to take, whether to take them with food, and what to
do if you miss a dose.
•• If you’re concerned about cost, talk to your healthcare
provider. There may be a less expensive drug or generic
form you can use instead.
•• Make your medications part of your daily routine.
For example, take them when you brush your teeth.
•• Make sure your healthcare providers know what
other medications you’re taking. This includes overthe-counter medications or supplements. Sometimes
these can interfere with your prescription medications.
•• Plan ahead for refills. Many doctor’s offices won’t refill
medications on weekends. Always make sure you have a
one-week supply.
•• Do NOT stop taking your medications, unless your
healthcare provider tells you to. Even if your blood
pressure has reached its goal, it may not stay there
without your medications.
Common blood pressure medications
The table below lists the most common categories of blood pressure medication. Your healthcare provider will prescribe
the best medications for your unique situation.
Category
How these medications help
Common examples
Angiotensin
converting
enzyme (ACE)
inhibitors
ACE inhibitors lower blood pressure by helping the blood vessels
open wider. They also work directly to reduce urine proteins.
ACE inhibitors may cause a cough. If they do, contact your
healthcare provider.
benazepril, captopril, enalapril,
fosinopril, lisinopril, moexipril,
perindopril, quinapril, ramipril,
trandolapril
Angiotensin
receptor
blockers (ARBs)
ARBs also help blood vessels open wider, helping to lower the blood
pressure. ARBs also reduce urine proteins.
azilsartan, candesartan,
eprosartan, irbesartan, losartan,
olmesartan, telmisartan, valsartan
Diuretics
Diuretics (“water pills”) help the kidneys reduce the amount of sodium
and water in the body, which reduces blood pressure. Your doctor may
prescribe more than one diuretic at a time.
bumetanide, chlorthalidone,
furosemide, hydrochlorothiazide,
metolazone, torsemide
Aldosterone
receptor
antagonists
Aldosterone receptor antagonists trigger the kidneys to get rid of
unneeded water and sodium through urine. This lowers the volume
of blood that the heart must pump, which lowers blood pressure.
eplerenone, spironolactone
Calcium channel
blockers
Calcium channel blockers keep calcium from entering the cells of
your blood vessels. This helps them open wider so blood pressure
goes down.
amlodipine, diltiazem,
felodipine ER, isradipine,
nifedipine ER, verapamil
Beta blockers
Beta blockers reduce nerve impulses to your heart and blood vessels.
This decreases the force of the heartbeat to lower blood pressure.
atenolol, bisoprolol, carvedilol,
labetalol, metoprolol, metoprolol
ER, nadolol, nebivolol,
propranolol
Alpha blockers
Alpha blockers reduce nerve impulses to blood vessels, allowing
blood to flow more easily.
doxazosin, prazosin, terazosin
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Monitoring your blood pressure
Other Intermountain resources
Your healthcare provider may ask you to monitor your
blood pressure regularly at home. Monitoring helps you
and your healthcare provider see how well lifestyle
changes and medications are controlling your blood
pressure. This can help fine-tune your treatment plan.
The following resources can help you learn more about
high blood pressure and control it effectively:
Many types of blood pressure monitors are available.
You can purchase them at drugstores, supermarket
pharmacies, or other large stores. Here are some tips
for choosing and using a blood pressure monitor:
•• Choose a monitor with a cuff that wraps around the
upper arm, and make sure the cuff is the right size.
•• BP Basics: This booklet gives you more
details on lifestyle changes and other
treatments for high blood pressure.
•• BP Tracker: This tracker gives you
an easy way to record your blood
pressure regularly.
•• Look for a monitor that also shows your heart rate.
•• Try to get readings at a consistent time each day,
usually morning or evening. Don’t take your blood
pressure within a half hour of eating a heavy meal,
using caffeine, exercising, or using tobacco.
•• Sit quietly for 5 minutes before taking your blood
pressure. It’s also a good idea to take 3 readings about
5 minutes apart.
•• If you can, rest your arm on a table or on the arm of a
chair, at the level of your heart. Rest both feet flat on
the floor.
•• Bring your monitor to your doctor’s office visits. Your
doctor may check that the monitor readings are similar
to your in-office BP checks. This can help you feel more
confident about your readings at home.
“I loved salt — and salty foods — but I
“I didn’t want to take blood pressure
I didn’t have any problem. And now that I’m
walking every day and I’ve lost some weight,
my doctor said I can take a lower dose.”
knew my kidneys were worth making
some changes in my diet. I thought it
would be tough. But I was surprised...
my taste buds adjusted pretty fast. Within a few weeks, I didn’t miss the salt as much. And now, when I
take a potato chip off my husband’s plate, it tastes
way too salty for me.”
— Elaine, kidney patient
pills because my cousin said he had
heard they have a lot of side effects. But
my doctor said only 1 in 10 people have
annoying side effects, and if that happens,
the doctor can change the medication.
— Marcos, kidney patient
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it should not be used to diagnose or treat a health problem or disease. Please consult your healthcare provider if you have any questions or concerns. More health information is
available at intermountainhealthcare.org. Patient and Provider Publications 801-442-2963 FS315 - 01/14 Also available in Spanish.
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