What is blood pressure?
Blood pressure is the pressure of blood pushing against the walls of your arteries. Arteries carry blood from your heart to other parts of your body. Your blood pressure normally rises and falls throughout the day.
Blood pressure that is too low is called hypotension, pressure that is consistently too high is called hypertension, and normal pressure is called normotension. Both hypertension and hypotension have many causes and may be of sudden onset or long duration. Long-term hypertension is a risk factor for many diseases, including stroke, heart disease, and kidney failure. Long-term hypertension is more common than long-term hypotension.
Severe high blood pressure can harm kidney function over a relatively short period, mild forms of high blood pressure can damage kidneys over several years.
Blood pressure is measured using two numbers. The top number in a blood pressure measurement is called systolic pressure. This measures the force of blood against the walls of the arteries when the heart is pumping. The lower number is called the diastolic pressure. This measures the force of the blood when the heart is between beats. Both numbers are important and need to be controlled. Though individuals vary, generally a blood pressure before dialysis should be less than 150/90 and after treatment should be less than 130/80
High blood pressure can constrict and narrow the blood vessels in your kidneys, which reduces blood flow and stops the kidneys from working well. When this happens, the kidneys are not able to remove all wastes and extra fluid from your body. Extra fluid in the blood vessels can raise your blood pressure, even more, creating a dangerous cycle, and causing more damage leading to kidney failure.
What happens when Blood Pressure (BP) is too high?
Common dangers of high blood pressure are stroke, heart attack, and vessel diseases. High BP can cause congestive heart failure due to an increased load on the heart. Damage to vessel walls leads to atherosclerosis. In many dialysis patients, high blood pressure prompted renal failure in the first place: the high force of blood, pushed into very small vessels of the kidney causing scarring and thickening of those vessels and leading to permanent damage.
High blood pressure often has no warning signs or symptoms, so many people don't realize they have it. Some symptoms may include headache, blurred vision, nervousness, sweating, difficulty sleeping, or facial flushing. Even with no symptoms, hypertension needs ongoing treatment to protect the heart, kidneys, and other organs from further damage.
What to watch out for with low blood pressure.
Blood pressure is checked in all medical settings, but it is even more significant for patients on dialysis. Low blood pressure, or hypotension, can create problems during dialysis. Know the symptoms so you can alert staff and get treatment quickly. Common symptoms of low blood pressure can include dizziness, nausea, headaches, muscle cramps, and, in more severe cases, chest pain and loss of consciousness. Blood pressure may drop at any time during treatment. Often, the cause is a decrease in the volume of fluid in the bloodstream. Hypotension can occur even when your tissues are fluid overloaded.
What can you do to control blood pressure?
To minimize the risk of hypertension (high blood pressure) control sodium, potassium, and other essential electrolytes the body uses to maintain fluid balance. The recommendation for patients with renal failure and kidney disease: limit sodium intake to no more than 1,500 mg per day. Most sodium in your diet comes from processed foods, fast foods, and restaurant foods. Unhealthy lifestyle choices, such as smoking tobacco, obesity, and excessive alcohol consumption, may also contribute to hypertension.
To prevent hypotension (low blood pressure) during dialysis, take in adequate protein, as it helps fluid move from tissues into the bloodstream. The protein level is usually reflected as albumin in the lab. Patients are often encouraged to increase consumption of fish, eggs, and chicken when albumin is low. Another important way to avoid hypotension is to keep fluid intake low between treatments so the change in body fluid isn't so drastic. Removal of large amounts of fluid makes the treatment much harder on the heart. Weight gains between treatments should be no more than 5% of dry body weight.
Treatment for blood pressure.
Blood pressure medication can affect dialysis. A doctor should advise patients when to take medication on dialysis versus non-dialysis days, If a patient takes BP medication at night, and then arrives at dialysis with very high blood pressure in the morning, either:
Fluid gains are too high, or
The evening dose is not adequate.
The patient can check their blood pressure at home morning and evening and keep a record of it. This can help the doctor optimize timing and dosages.
The doctor may recommend postponing some medications before treatment on dialysis days, especially if a patient's blood pressure falls during treatments. However, some medications protect the heart. Any alteration must be supervised by the doctor.
Controlling blood pressure is key to lowering the risk of complications and achieving more comfortable treatment.
Blood Pressure Log Free Download
We created a blood pressure log to help you keep track of your blood pressure readings. Just click on the file below to download the PDF, print, and use it every time you take your blood pressure. Record your blood pressure on this sheet and show it to your doctor at every visit.
Source: CDC, NIDDK
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