The Relationship Between Blood Pressure and Kidneys

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Luke Laffin, MD:

Hello, my name's Luke Laffin, I'm a preventive cardiologist, and co-director for the Center for Blood Pressure Disorders here at the main campus of the Cleveland Clinic. It's great to speak with you today about the connection that we see between the kidneys and the heart. And really, how does that play into blood pressure and all those other factors? A wise mentor once told me that the kidneys and the heart are like a married couple. Okay? If one's not happy, the other one probably isn't happy as well. And I've always taken that to heart, no pun intended, to think about how medications that we take and how we address cardiovascular risk factors can also have an impact on any type of kidney disease or the health of the overall cardiovascular system.

Luke Laffin, MD:

It's important to realize that in multiple disease states, the kidneys and heart have a bidirectional relationship. And what do I mean by that? Well, let's just take the example of hypertension. Hypertension can ultimately lead to kidney disease, which can ultimately lead to worsening hypertension. Hypertension ultimately leads to thickening of the heart muscle, it's called left ventricular hypertrophy, and then can in certain circumstances lead to heart failure, amongst other cardiovascular complications, including atrial fibrillation, coronary artery disease, aortic dissections, et cetera. So thinking about them together is going to be really important longterm.

Luke Laffin, MD:

It's also important to realize that patients with kidney disease don't die of quote-unquote kidney disease. We have technologies that can extend life: dialysis, kidney transplants, et cetera. Why do they die? They die of cardiovascular disease, the vast majority, particularly as kidney function declines. There's really good data showing that as the level of kidney function declines, the most common measurement for that is the estimated glomerular filtration rate or the GFR. So as it declines, even below 75, we see at each stepwise progression, a higher incidence of cardiovascular disease. The same can be said for kidney disease, which is actually noted via the presence of protein in the urine. The more protein or albumin urea that you have in the urine, or that's detected, the worse people tend to do from a cardiovascular disease perspective.

Luke Laffin, MD:

Now, the good thing is that there's medications that can be used that are helpful for the heart and helpful for the kidneys in terms of reducing proteinuria, et cetera. And so keeping that in mind is going to be really important. There's certain medication classes that we tend to prefer in patients with chronic kidney disease to ultimately preserve renal function. So that's certain classes of blood pressure medicines above others. So it's really important to talk with your doctor, be it your primary care doctor, be it your cardiologist, perhaps it's your nephrologist as well, to think about what the right combination of medications is for you.

Luke Laffin, MD:

If we step outside just looking at hypertension and its role with kidney disease and heart disease, we also have to think about dyslipidemia or cholesterol issues as well. We know that chronic kidney disease, because it increases risk of things like strokes and heart attacks, oftentimes those patients will do better if they're taking cholesterol lowering medicines. So there's certain statins that have a little bit better data in terms of cardiovascular risk reduction. The example I always use is, atorvastatin tends to be a little bit better for preserving renal function than rosuvastatin. Those are respectively Lipitor and Crestor. And so asking your doctor those questions is important moving forward, to understand that we don't really want to be just looking or at one organ in particular, organ centric so to speak, taking a step back. And oftentimes you're primary care physician is really good at doing that and saying, "Okay, well we need a little bit of this, but we also want to be mindful of your kidneys, liver, et cetera." So keeping that in mind is going to be really important.

Luke Laffin, MD:

Other factors to really think about when we're thinking about the kidneys and how they impact cardiovascular disease is the impact that we can see in the setting of heart failure. We know that patients with heart failure, more often than not, have some underlying degree of kidney disease as well. And that may be because of some of the common precursors, hypertension, diabetes, et cetera, but it's also the hemodynamics within the body itself can lead to a decreased perfusion of the kidneys, it can lead to increased vascular congestion around the kidneys, which ultimately reduces kidney function. Again, certain medicines, particularly newer classes of medicines, such as the SGLT2 inhibitors, tend to be very well tolerated in patients with heart failure and kidney disease. So talking with your doctor about that is going to be really important.

Luke Laffin, MD:

So as a parting thought, so to speak, we'll oftentimes keep an eye on kidney function because we're taking medications for blood pressure, for cholesterol, et cetera. And don't be alarmed or worried if there is a blip or an abnormality in your kidney function, understand it's pretty common and we see it. But don't dismiss it either, talk to your doctor, see if there's anything that needs to be done to reduce your cardiovascular risk and reduce your risk for progression of chronic kidney disease. Thanks very much.

Announcer:

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