Hypertension and Negative Effect on Kidneys

Background

Over the world, it is approximated that over a billion people suffer from hypertension. It is a common chronic illness with huge kidney problems and cardiac complications. Also, it is a major risk for heart attacks and a leading cause of strokes. Therefore, it is important that strategies be put in place for its control and treatment to prevent it from reaching a level where it damages the eyes, kidneys, heart blood vessels, and other vital body organs in the human body (Hughson et al., 2006). Preventive measures on all overall risks factors like dyslipidemia state, physical inactivity, obesity, smoking and diabetes should be applied. Hypertension leads to low blood flow to various organs of the body due to the blocking of blood vessels and the result is that some organs like kidneys may fail and due to that, other complications may arise.

The manifestations of hypertension are observed by the sustained increase in blood pressure. It has many causes but blood pressure increase in both systole and diastole is a major cause. In the general population, high blood pressure increases the risks of diseases even though it is not a pathogenic factor. Arbitrarily, hypertension refers to a situation where sustained diastolic pressure has risen above 90 mmHg. Elevation of blood pressure with age would be referred to as primary hypertension. This type of hypertension appears after the age of 40 and represents worldwide cases of up to over 90% (Agarwal, R. 2005). It is important to note that the interaction between genetic predisposition, physical activities, alcohol consumption, obesity, and other factors forms the high blood pressure phenotype in hypertension. Unlike primary hypertension which does not have an apparent cause secondary hypertension has an identifiable cause and represents 10% of all worldwide cases (Hughson et al., 2006). The cause of secondary hypertension lies in the frequent renovascular disease which activates the renin-angiotensin-aldosterone causing blood pressure to rise. The classification of both the primary and secondary hypertensions can be done in two ways depending on their clinical course.

Statement of the problem

High blood pressure (hypertension) affects several parts of the kidney. For instance, ischemia in the nephron is produced by progressive arteriosclerosis. This destroys the atrophy of the tubular system and the glomeruli. It is important to note that this disease spreads from one nephron to another until an individual develops complete and chronic renal failure due to less number of the functional nephron. A kidney is said to be suffering from hypertensive nephrosclerosis when there is a significant production of ischemia.

The objective of the research proposal

This research study will seek to establish how hypertension affects kidneys negatively due to structural alterations. Emphasis is given on atherosclerosis hypertension and how it may alter the stenosis of the renal artery during surgical treatment that interferes with a blood pressure of the patient. Elevated levels of angiotensin II and rennin from an ischemic kidney will be investigated in relation to how they affect blood pressure

Literature review

Research studies have indicated that there is hope for the patients who are suffering from chronic hemodialysis. According to recent analysis, chronic hemodialysis patients can be cured from hypertension and eventual death through controlling systolic blood pressure (Agarwal, R. 2005). This kind of hypertention control is normally done prior to administering treatment to patients with chronic hypertensive hemodialysis. This method of treatment has become a preferred method of treating kidney failure in both advanced and permanent levels. Research studies have indicated that better treatment minimizes side effects and works efficiently with proper coordinated efforts. Basically, healthy kidneys perform the function of cleaning an individual’s blood by removing wastes, minerals and excess fluid (Agarwal, R. 2005). Failure of a kidney to perform the aforementioned tasks results accumulation of toxic materials in the body giving rise to retention of body fluids and the eventual rise in blood pressure. According to research studies, the process of hemodialysis works through a machine that allows blood to flow as it gets filtered. Extra fluids and wastes are removed in that process and as such, proper balance of chemicals in the body like sodium and potassium is maintained and pressure of the blood gets controlled (Agarwal, R. 2005).

In other studies done on adults in the US by the American Society of Nephrology and the CDC, researchers have found out that there is an increase in the prevalence of Chronic Kidney Disease (CDK). These studies have indicated that cardiovascular diseases, kidney failure and premature deaths are some of the grave effects of the progression and development of hypertension (CDC, 2010). CDK condition indicates a complete failure of the kidney due to damage caused by wastes materials building up in the body. This damages the kidneys and may lead to other diseases like bone disease, anemia and the cardiovascular diseases (CVD). Doctors who need to assess the condition of the kidney to determine whether there is CDK carry out a urine test. Also, a blood test is done to estimate the function of the Kidney. Additionally, CDK, being a progressive and irreversible disease, can eventually cause End Stage Renal Disease (ESRD) which is a complete kidney failure (CDC, 2010). However, CDK patients can be treated through lifestyle changes and medication as well as through kidney transplant or dialysis for End Stage Renal Disease (ESRD).

It is important to note as aforementioned, that in the US, CDK is most common among the adults with emphasis on the women who are most affected. It is also found among diabetes and hypertension patients. This is so because diabetes or hypertension in an individual increases the risks of developing CDK. Besides, a family history of CDK, elevated cholesterol, obesity, and CVD are other risk factors that may lead to an individual developing CDK (CDC, 2010). As an individual grows older, kidney disease becomes a common risk factor and so is the developing of CDK. Among the elderly, CDK progression may lead to ESRD if hypertension and diabetes are inappropriately controlled (Lea et al., 2005). In addition, toxins, drugs and other infections may be injurious to the kidney and repetitions of acute kidney injury episodes may lead to the progression of CDK.

Moreover, strokes, heart rhythm disturbance, heart failure, heart failure and other cardiovascular diseases are important risk factors for CDK. Cardiovascular diseases have risk factors such as elevated cholesterol, excessive weight, elevated blood sugar and high blood pressure that is uncontrolled. All these require proper medical attention in people with CDK. Hypertension and diabetes are the leading causes of ESDR. Other less causes include malignancies such as myeloma, hereditary kidney disease and the glomerulonephritis (CDC, 2010). The research studies carried out in 2007 indicated that more African Americans are susceptible to ESDR than whites. However, in the period between the years 1998-2005 research indicated that the disparity in ESDR between African Americans and the whites narrowed. The inability of the kidney to perform its important role of removal of waste products also referred to as kidney failure puts a hypertension patient in a dangerous situation and as such, the survival of that patient solely relies on kidney transplantation or dialysis. In 2007, over 110,000 patients suffering from ESRD started their treatment.

Reports from the research studies carried out in the year 2000-2007 indicate that there has been an improvement in the clinical management of the ESRD indicated by 21% fall in the incidence of glomerulonephritis (CDC, 2010). This is an important step in reducing the mortality rate due to CDK and ESRD. Also, the reduction of CDK and ESDR incidences saves individuals from having reduced quality of life, anemia, mineral and bone disorders, potassium and sodium imbalances and fluid overload. Additionally, it will cardiovascular diseases, hypertension, diabetes and other chronic diseases in adults with CDK will be minimized.

In another study done among the participants from southeastern US, links between mean arterial blood pressure (MAP) and total glomerular number (N-glom) have been shown. The researchers have done a critical analysis and have realized that there is a link between developments of hypertension due to low number of nephron among the African Americans compared to the whites (Hughson et al., 2006). Hypertensions and low birth weights have been related to low nephron numbers. Research conducted by the Center for Chronic Disease, the University of Mississippi Medical center and the Monash University have indicated that the prevalence of chronic kidney disease due to hypertension among the African Americans and the whites in the southeastern United States is high and that in African Americans it is five times higher than among whites. Through extensive analysis conducted by the researchers, it was observed that there was a link between birth weight, blood pressure and glomerular number (N-glom) in whites and southeastern African Americans. This data was collected using a fractionater/ physical dissector technique to obtain stereological estimates of glomerular number (N-glom) from adults (Hughson et al., 2006). From the kidney autopsy results, the number of African Americans who were hypertensive was higher compared to the whites while normotensive subjects were whites more than African Americans. In a nut shell, white subjects develop hypertension dye to low birth weight and possibly a low nephron number (Hughson et al., 2006).

Moreover, in another study done by researchers from the Emory University School of Medicine, it was found out tat there is a link between cardiovascular events, ESRD development and progress with the degree of protenuria (Lea et al., 2005). In the research study, the relationship between Glomerular Filtration Rate (GFR) and early changes of protenuria to kidney disease due to long term progression of hypertensive nondiabetic condition.. The results of the post hoc analysis ware that the rate of decline of rgate of GFR depended on the changes of the baseline protenuria and GFR (CDC, 2010). Both GFR and protenuria were found to be important in predicting hypertensive kidney disease, its development and progression (Lea et al., 2005).

Additionally, other studies have linked augmentation index and pulse pressure both of which are aspects of hypertension to damage of micro vascular networks in the kidney (O’Rourke & Safar, 2005). Even though the association has not been established, the mechanism of that relationship can be explained using a logical pathophysiological basis whereby systemic vascular beds are compared with the input impendence in the kidney and brain (O’Rourke & Safar, 2005). Blood pressure difference can be observed in these organs as being of low resistance and torrential flow. This exposes the small arterial vessels in the renal, vertebral and carotid arteries to high pressure fluctuations. It is important to note that this pressure increases with age up to about 3-4-fold (O’Rourke & Safar, 2005). The central pulse pressure fluctuations exposes blood vessels to high flow and pulsatile pressure leads to damage of micro vascular vessels. This damage is the reason for intellectual deterioration and the renal insufficiency. Such complications require logical therapeutic interventions such as reduction of wave reflection and central pulse pressure. Other remedies include drugs such as angiotensin receptor blockers, angio-tensin converting enzyme inhibitors, calcium channel blockers and nitrates (O’Rourke & Safar, 2005). This helps in ensuring in reduction of wave reflection by dilating conduit arteries.

Research design and hypothesis

In this research proposal, both independent and dependent variables will be used to conduct the empirical study in order to determine whether hypertension affects the functionality of the kidney. These independent variables will include cholesterol levels in the body of the participants, body weight in relation to body mass index (BMI), individual family history of CDK and the prevalence level of CVD. The dependent variable will be the observed effect of hypertension on the performance of kidney.

Hypothesis

Hypertension has a negative impact on the performance of kidney especially among patients with predisposed conditions such as CVD and CDK family history of CDK, elevated cholesterol, obesity, and CVD

Measurement and Data Collection

In this research proposal, measurement and data collection will be carried out among 3000 participants from a Normative Age and between the ages of 21-80 years. Participants will be free to know of their chronic medical conditions as one of the major ethical requirements when conducting research studies in such area. Detailed medical procedures will be done including the use of questionnaires, laboratory tests, routine physical examinations and gathering information from medical history of the individual participants. This is necessary in order to establish the medical background of each of the respondent. The systolic and diastolic blood pressure mean will be determined in each of the participants from their right and left arms to find out those whose blood pressures have gone above the required standard. It is important to note that diastolic blood pressure greater than or equal to 95mmHg and systolic blood pressure which is greater than or equal to 160mmHg defines a hypertensive person. Another way of determining this will be through a physicians test with the use of antihypertensive medication.

Additionally, there will be grouping of individuals according to their BP levels. The groups will be divided such that there will be the normotensive control patients, pre-hypertensive patients and hypertensive patients of first and second stages. To determine systolic and diastolic PB, a korotkoff sound machine will be used and in order to measure the BP of each participant, a mercury sphygmomanometer will be used. During the study, patients who have any systematic disease such as erythematosus, systemic lupus and diabetes mellitus won’t be included. Other groups of people that will be excluded are those who use hypertensive drugs, vasoactive drugs and smoke.

Conclusion

In conclusion, the process of chronic renal failure cannot be stopped by any form of medication. However, there are a number of strategies that can be applied and that have been successful in retarding the progress of renal failure due to hypertension. Hypertension can be monitored and be treated using medical drugs. However, there is need to monitor blood pressure to ensure that it maintains a balance and that it does not go above 130/80. Additionally, individuals should work on their dietary plans by reducing phosphate in their diets and restricting the amount of proteins in the diet to 0.6-0.8 gm. We anticipate a positive correlation between hypertension and deteriorating kidney conditions among participants with family history of CDK as well as those diagnosed with pre conditions affecting terminal health such as cardiovascular complications.

References

Agarwal, R. (2005). Hypertension and survival in chronic hemodialysis patients-past lessons and future opportunities. Kidney International, 67, 1-13.

Center for Disease Control and Prevention. (2010). National chronic kidney disease fact sheet: General information and national estimates on chronic kidney in the United States, 2010. Atlanta, GA: U.S. Department of Health and Human Services, CDC.

Hughson, M.D. et al. (2006). Hypertension, glomerular number, and birth weight in African Americans and white subjects in the southeastern United States. Kidney International, 69, 671-678.

Lea, J. et al. (2005). The relationship between magnitude of protenuria reduction and risk of end-stage renal disease: Results of the African American study of kidney disease and hypertension. Arch Intern Med. 165 (8), 947-53.

O’Rourke, M.F. & Safar, M.E. (2005). Relationship between aortic stiffening and microvascular disease in brain and kidney: Cause and logic of therapy. Hypertension, 46, 200-204.

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