Kidney health

Controlling blood pressure

High blood pressure (hypertension) is a common cause of kidney impairment. Conversely, as the kidneys play a role in blood pressure regulation, kidney impairment can also lead to high blood pressure. Therefore it is common for people with kidney impairment to also have high blood pressure, and controlling blood pressure is an important way of preventing kidney impairment from worsening. Most people who have kidney impairment are prescribed medicines to lower their blood pressure, because even small increases in blood pressure can have a big impact on kidney health.

Most of the people we spoke to with kidney impairment also had high blood pressure. Some were living with other long term conditions too, such as diabetes, heart disease or arthritis, resulting in them having to take lots of different medicines, including blood pressure lowering drugs.
People commonly said that they had felt unhappy at first about having to take medicines, but over time they had learned to accept that it was necessary to keep them well. Roy had been concerned to learn he needed treatment for high blood pressure and cholesterol because cardiovascular disease runs in his family. Justine had felt far too young to start needing treatment for long term conditions when only in her early forties. John would have preferred to lower his blood pressure through exercise and diet but his GP suggested taking medicines would be more effective.
Other people said they still disliked having to take medicines even after many years. Donald wished he could reduce the number of medicines he was taking.
Sarah liked to find out information and weigh up the pros and cons of taking particular medicines. Harry said he always asks his doctor questions about his medicines, and his wife says they always read the leaflet in the packet to learn about possible side effects. Pat preferred not to know this information. Peter felt that doctors sometimes made treatment decisions without asking the patient’s preferences.

Some people negotiated with their doctor to try lowering the dose of a medicine or stop it altogether. Jim B took a break from blood pressure tablets during which he controlled it using diet, exercise and meditation, but after a year was advised to take a different blood pressure lowering medicine. Anne and Peter, who were taking diuretics (water tablets) to treat high blood pressure or other conditions, had been given permission by their doctor to alter the dose themselves on a day-by-day basis depending how much fluid retention they were experiencing. Lesley had done this without telling her doctor because she finds she has difficulty sleeping when she takes too many diuretic pills, and her arthritis seems more painful.
Alongside their useful effects, most drugs can also cause unwanted side effects, but not everyone experiences them. There are many different medicines that can be used to treat high blood pressure. The possible side effects vary between medicines and people react to medicines in different ways.

Many people we spoke to said they had experienced no problematic side effects of their medicines. Some recalled having side effects when they first started taking a medicine but which later wore off, such as ankle swelling, headache, nausea or a dry mouth. Other effects might be experienced only occasionally or were not particularly troublesome. For instance, Ken had sometimes felt light-headed in hot weather, and Laura felt generally colder than she used to and once became dehydrated without realising it. If side effects are more problematic people may be taken off a particular medicine and tried on a different one instead. Justine was taken off nifedipine because it made her feel dizzy and nauseous. Robert was taken off a beta blocker because it made him feel like a zombie, and Gerald because it caused him breathing difficulties. Roy said the first blood pressure medicine he took made him feel drowsy and hot.
Some types of blood pressure lowering medicines can also reduce the ability of the kidneys to filter waste products from the blood, but a small reduction in the estimated glomerular filtration rate (eGFR) (see ‘How and why is kidney function monitored?’) can be tolerated because these medicines offer long term protection against cardiovascular disease. However, people may occasionally experience a bigger drop in their eGFR and should stop taking these types of medicines. For instance, tests showed that Jim B’s eGFR had dropped to a low level while he was taking ramipril but it rose again after he stopped taking this medicine.

It is usually recommended that blood pressure medicines are taken at roughly the same time of day every day, but this can be hard to remember. People described having a routine to help them remember, such as keeping their medicines on the bedside or kitchen table to take in the morning or at bedtime. Remembering to take medicines in the middle of the day could be more difficult, especially if people were away from home. Laura said that having the days of the week printed on the blister pack that the pills came in helped her to know whether she had taken it not, although on occasions she thought she had taken two of the same tablet.
Others used the compartments of a dosette box to put out ready the pills they needed to take on a daily or weekly basis; Bernard and Pat said their partner did this for them.
Some of the people we interviewed had only recently started taking blood pressure medicines, while others had taken them for many years and said their blood pressure was stable or well controlled as a result. Jackie had taken them since childhood. Flo and Margaret had been treated for high blood pressure when they were pregnant but not again until later in life. Some people said that reducing sources of stress in their life had helped to lower their blood pressure. Robert says his blood pressure has come down since he retired from work.

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