Question

A client has a long history of hypertension medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?

Answer 1

How can people prevent or slow the progression of kidney disease from high blood pressure?

The best way to slow or prevent kidney disease from high blood pressure is to take steps to lower blood pressure. These steps include a combination of medication and lifestyle changes, such as

• healthy eating
• physical activity
• maintaining a healthy weight
• quitting smoking
• managing stress

No matter what the cause of the kidney disease, high blood pressure can increase damage to the kidneys. People with kidney disease should keep their blood pressure below 140/90.⁴

Medication

Medications that lower blood pressure can also significantly slow the progression of kidney disease. Two types of blood pressure-lowering medications, angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), have been shown effective in slowing the progression of kidney disease. Many people require two or more medications to control their blood pressure. In addition to an ACE inhibitor or an ARB, a health care provider may prescribe a diuretic—a medication that helps the kidneys remove fluid from the blood. A person may also need beta blockers, calcium channel blockers, and other blood pressure medications.

Eating, Diet, and Nutrition

Following a healthy eating plan can help lower blood pressure. A health care provider may recommend the Dietary Approaches to Stop Hypertension (DASH) eating plan . DASH focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and lower in sodium, which often comes from salt. The DASH eating plan

• is low in fat and cholesterol
• features fat-free or low-fat milk and dairy products, fish, poultry, and nuts
• suggests less red meat, sweets, added sugars, and sugar-containing beverages
• is rich in nutrients, protein, and fiber

A dietitian may also recommend this type of diet for people who have already developed kidney disease. A diet low in sodium and liquid intake can help reduce edema and lower blood pressure. Reducing saturated fat and cholesterol can help control high levels of lipids, or fats, in the blood.

Health care providers may recommend that people with kidney disease eat moderate or reduced amounts of protein, though the benefits of reducing protein in a person’s diet is still being researched. Proteins break down into waste products that the kidneys filter from the blood. Eating more protein than the body needs may burden the kidneys and cause kidney function to decline faster. However, protein intake that is too low may lead to malnutrition, a condition that occurs when the body does not get enough nutrients. People with kidney disease who are on a restricted protein diet should be monitored with blood tests that can show low nutrient levels.

In addition, consuming too much alcohol raises blood pressure, so people should limit alcoholic drinks—two per day for men and one per day for women.

A health care provider can help people change their diet to meet their individual needs.

Physical Activity

Regular physical activity can lower blood pressure and reduce the chances of other health problems. A health care provider can provide information about how much and what kinds of activity are safe. Most people should try to get at least 30 to 60 minutes of activity most or all days of the week. A person can do all physical activity at once or break up activities into shorter periods of at least 10 minutes each. Moderate activities include brisk walking, dancing, bowling, riding a bike, working in a garden, and cleaning the house.

Body Weight

People who are overweight or obese should aim to reduce their weight by 7 to 10 percent during the first year of treatment for high blood pressure. This amount of weight loss can lower the chance of health problems related to high blood pressure. Overweight is defined as a body mass index (BMI) —a measurement of weight in relation to height—of 25 to 29. A BMI of 30 or higher is considered obese. A BMI lower than 25 is the goal for keeping blood pressure under control.⁵

Smoking

People who smoke should quit. Smoking can damage blood vessels, raise the chance of high blood pressure, and worsen health problems related to high blood pressure. People with high blood pressure should talk with their health care provider about programs and products they can use to quit smoking.

Stress

Learning how to manage stress, relax, and cope with problems can improve emotional and physical health. Some activities that may help reduce stress include

• exercising
• practicing yoga or tai chi
• listening to music
• focusing on something calm or peaceful
• meditating