High blood pressure affects more than a billion people worldwide and is one of the biggest risk factors for heart disease and stroke.
Because it often causes no obvious symptoms, many people can have dangerously high blood pressure for years without knowing it.
Medicines play an important role in bringing blood pressure under control. Lowering it can greatly reduce the risk of a heart attack, stroke, kidney disease and other serious health problems.
Doctors have several types of blood pressure medicines to choose from. These include water pills, calcium channel blockers, beta-blockers, ACE inhibitors and angiotensin receptor blockers, often called ARBs.
Researchers at the University of Virginia have now discovered something interesting about how some commonly used blood pressure medicines may affect the kidneys over time. The research was led by Dr. Maria Luisa Sequeira Lopez.
The scientists focused on ACE inhibitors and ARBs. These medicines lower blood pressure by interfering with a natural system in the body that helps control blood pressure, fluid levels and the amount of salt the body keeps.
The kidneys play an important role in this system. Special kidney cells produce a substance called renin when the body needs help raising blood pressure or maintaining the right balance of salt and water.
ACE inhibitors and ARBs reduce the activity of this blood-pressure system. Because of this, the kidneys may respond by encouraging more cells to produce renin.
The researchers found that long-term stimulation of these cells could lead to unexpected changes. Some kidney cells began producing renin and appeared to contribute to thickening in the walls of small blood vessels inside the kidneys.
Over time, these changes could potentially make the blood vessels thicker and less flexible. That raises questions about whether long-term changes in these cells could affect kidney health in some circumstances.
However, the findings should not be taken as evidence that people should stop taking ACE inhibitors or ARBs. These medicines have been studied extensively and can provide major benefits, particularly for people with high blood pressure, heart disease, heart failure or certain kidney problems.
In fact, ACE inhibitors and ARBs are often prescribed specifically because they can protect the kidneys in people with conditions such as diabetes. The new research instead helps scientists understand more about what happens inside the kidneys during long-term treatment.
People taking these medicines should not suddenly stop them without medical advice. Uncontrolled blood pressure itself can seriously damage the kidneys, heart, brain and blood vessels, and stopping treatment can cause blood pressure to rise.
The study also highlights why doctors monitor more than blood pressure when treating hypertension. Blood tests and other checks can help doctors watch kidney function and make sure a medicine continues to be appropriate for an individual patient.
Lifestyle changes remain another important part of controlling blood pressure. Eating less salt, staying physically active, maintaining a healthy weight, limiting excessive alcohol and avoiding smoking can all support healthier blood pressure.
Checking blood pressure at home can also provide useful information. Because blood pressure changes throughout the day, a series of home readings can sometimes give doctors a clearer picture than a single measurement taken in a clinic.
The larger message from the research is that blood pressure treatment involves balancing many factors. A medicine that provides major benefits can also cause biological changes that scientists need to understand more fully.
The University of Virginia research led by Dr. Maria Luisa Sequeira Lopez was published in the scientific journal JCI Insight. Further research will be needed to determine exactly what these kidney changes mean for people receiving long-term treatment.
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