How is hypertensive nephropathy treated?

Written by Li Liu Sheng
Nephrology
Updated on January 10, 2025
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Long-term hypertension can lead to abnormal kidney structure and function, also known as hypertensive nephropathy. Once hypertensive nephropathy is diagnosed, comprehensive treatment measures are often adopted, including both pharmacological and non-pharmacological treatments. In terms of non-pharmacological treatment, patients should maintain a low-salt diet in their daily life, focusing on a light diet, with a daily salt intake of about 4 grams. Regarding pharmacological treatment, the main goal is to control the patient's blood pressure and reduce urinary protein. Medications that can be used include angiotensin-converting enzyme inhibitors or angiotensin II receptor antagonists. Any of these medications can be chosen and used long-term to control blood pressure, protect kidney function, and reduce urinary protein. (Medications should be used under the guidance of a physician, and self-medication should be avoided.)

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Cardiology
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Hypertensive crisis blood pressure values

At any stage of hypertension development and other disease emergencies, severe life-threatening blood pressure increases can occur, requiring emergency treatment. Hypertensive crises include hypertensive emergencies and hypertensive urgencies. Hypertensive emergencies refer to severe blood pressure increases within a short time—hours or days—with diastolic pressure greater than 130 mmHg and/or systolic pressure greater than 180 mmHg, accompanied by severe dysfunction or irreversible damage to critical organs and tissues such as the heart, brain, kidneys, retina, and major arteries. Hypertensive urgencies may present as increased blood pressure but without obvious target organ damage.

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Cardiology
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What is hypertension?

Hypertension is characterized by elevated arterial blood pressure in the systemic circulation, and may be accompanied by functional or organic damage to organs such as the heart, brain, and kidneys. Hypertension can be divided into primary hypertension and secondary hypertension. Secondary hypertension is due to certain identified causes or etiologies, leading to increased blood pressure, accounting for about 5% of all hypertension cases. Conditions like primary aldosteronism, pheochromocytoma, renovascular hypertension, and renin-secreting tumors are examples, and cases where the cause of increased blood pressure cannot be found are also referred to as primary hypertension and hypertensive disease. Currently, the classification and standard for blood pressure in China mostly use a systolic pressure of greater than or equal to 140 mmHg and/or a diastolic pressure of greater than or equal to 90 mmHg.

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Written by Li Hai Wen
Cardiology
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Is it called hypertension if the diastolic blood pressure is high?

High diastolic pressure, which is an increase in diastolic pressure, is also considered hypertension when the diastolic pressure exceeds 90mmHg. If you have hypertension, it is essential to have a formal medical examination at a hospital, such as blood tests for lipids and glucose to check for diabetes and hyperlipidemia. Blood tests are also done to evaluate liver and kidney functions, to see if there are any kidney diseases causing the increase in blood pressure. Additionally, under the guidance of a doctor, conduct ambulatory blood pressure monitoring to observe the overall situation of blood pressure increase within 24 hours. Based on the results of the blood tests and ambulatory blood pressure monitoring, determine whether antihypertensive medication is needed and which type of medication to use.

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Obstetrics
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Pregnancy hypertension symptoms

The symptoms of hypertension during pregnancy vary depending on the blood pressure level, individual tolerance, and other factors. Common symptoms include high blood pressure, protein in the urine, and generalized edema. Edema can vary in severity; it can start with bilateral ankle swelling, progress to the calves, thighs, and then become generalized throughout the body. Increased blood pressure can also lead to headaches, dizziness, nausea, and blurred vision. In more severe cases, pain in the upper abdomen and convulsions may occur.

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How to lower high blood pressure?

Hypertension is divided into primary hypertension and secondary hypertension. If it is secondary hypertension, removing the factors that cause high blood pressure can cure it. For example, if the hypertension is caused by an adrenal tumor, removing the tumor can normalize blood pressure. However, if diagnosed with primary hypertension, lifelong medication is required. There are many types of medications available, which need to be specifically analyzed based on the individual situation. If the patient primarily has high systolic pressure, it is recommended to use some calcium channel blockers, which are commonly used for elderly patients who primarily exhibit high systolic pressure. If it is primarily high diastolic pressure, some ACE inhibitors or ARBs are suggested. If sympathetic excitement is predominant, some β-blockers can be used. (Medication should be taken under the guidance of a professional doctor.)