High Blood Pressure 

and Kidney Disease

 National Kidney and Urologic Diseases Information Clearinghouse 

U.S.	Department	 

of	Health	and		 

Human	Services 

NATIONAL		 

INSTITUTES	 

OF	HEALTH 

The kidneys play a key role in keeping a 

person’s blood pressure in a healthy range, 

and blood pressure, in turn, can affect the 

health of the kidneys. High blood pressure, 

also called hypertension, can damage the 

kidneys and lead to chronic kidney disease 

(CKD). 

What is high blood 

pressure? 

Blood pressure measures the force of blood 

against the walls of the blood vessels. Extra 

fluid in the body increases the amount of 

fluid in blood vessels and makes blood pressure higher. Narrow, stiff, or clogged blood 

vessels also raise blood pressure. 

People with high blood pressure should see 

their doctor regularly. 

Hypertension can result from too much fluid in 

normal blood vessels or from normal fluid in narrow, 

stiff, or clogged blood vessels. 

	Amount	 

	of	blood	 Diameter	of	 Blood	 

	in	vessel	 blood	vessel	 pressure 

High 

Normal 

High 

Normal 

High 

Normal 

Normal 

Normal 

Narrow 

Normal 

Too much 

Normal 

How does high blood 

pressure hurt the kidneys? 

High blood pressure makes the heart 

work harder and, over time, can damage 

blood vessels throughout the body. If the 

blood vessels in the kidneys are damaged, 

they may stop removing wastes and extra 

fluid from the body. The extra fluid in the 

blood vessels may then raise blood pressure even more. It’s a dangerous cycle. 

High blood pressure is one of the leading 

causes of kidney failure, also called endstage renal disease (ESRD). People with 

kidney failure must either receive a kidney 

transplant or have regular blood-cleansing 

treatments called dialysis. Every year, 

high blood pressure causes more than 

25,000 new cases of kidney failure in the 

United States.1 

What are the signs and 

symptoms of high blood 

pressure? 

Most people with high blood pressure 

have no symptoms. The only way to know 

whether a person’s blood pressure is high 

is to have a health professional measure 

it with a blood pressure cuff. The result 

is expressed as two numbers. The top 

number, called the systolic pressure, 

represents the pressure when the heart 

1

United States Renal Data System. USRDS 2007 

Annual Data Report. Bethesda, MD: National 

Institute of Diabetes and Digestive and Kidney 

Diseases, National Institutes of Health, U.S. 

Department of Health and Human Services; 2007.
 

is beating. The bottom number, called 

the diastolic pressure, shows the pressure 

when the heart is resting between beats. A 

person’s blood pressure is considered normal if it stays at or below 120/80, which is 

commonly stated as “120 over 80.” People 

with a systolic blood pressure of 120 to 139 

or a diastolic blood pressure of 80 to 89 

are considered prehypertensive and should 

adopt lifestyle changes to lower their blood 

pressure and prevent heart and blood vessel diseases. A person whose systolic blood 

pressure is consistently 140 or higher or 

whose diastolic pressure is 90 or higher is 

considered to have high blood pressure and 

should talk with a doctor about the best 

ways to lower it. 

What are the signs and 

symptoms of chronic kidney 

disease (CKD)? 

Early kidney disease is a silent problem, 

like high blood pressure, and does not have 

any symptoms. People may have CKD but 

not know it because they do not feel sick. A 

person’s glomerular filtration rate (GFR) 

is a measure of how well the kidneys are 

filtering wastes from the blood. GFR is 

estimated from a routine measurement of 

creatinine in the blood. The result is called 

the estimated GFR (eGFR). 

Creatinine is a waste product formed by the 

normal breakdown of muscle cells. Healthy 

kidneys take creatinine out of the blood 

and put it into the urine to leave the body. 

When the kidneys are not working well, creatinine builds up in the blood. 

An eGFR with a value below 60 milliliters per minute (mL/min) suggests some 

kidney damage has occurred. The score 

means that a person’s kidneys are not 

working at full strength. 

Another sign of CKD is proteinuria, or 

protein in the urine. Healthy kidneys take 

wastes out of the blood but leave protein. 

Impaired kidneys may fail to separate a 

blood protein called albumin from the 

wastes. At first, only small amounts of 

albumin may leak into the urine, a condition known as microalbuminuria, a sign of 

failing kidney function. As kidney function worsens, the amount of albumin and 

other proteins in the urine increases, and 

the condition is called proteinuria. CKD is 

present when more than 30 milligrams of 

albumin per gram of creatinine is excreted 

in urine, with or without decreased eGFR. 

How can kidney damage 

from high blood pressure 

be prevented? 

The National Heart, Lung, and Blood 

Institute (NHLBI), one of the National 

Institutes of Health (NIH), recommends 

that people with CKD use whatever 

therapy is necessary, including lifestyle 

changes and medicines, to keep their 

blood pressure below 130/80. 

2 High Blood Pressure and Kidney Disease 
 

How can blood pressure 

be controlled? 

The NHLBI recommends five lifestyle 

changes that help control blood pressure. People with prehypertension or 

high blood pressure should 

•	 maintain their weight at a level 


close to normal. 


•	 eat fresh fruits and vegetables, 


grains, and low-fat dairy foods.
 

•	 limit their daily salt, or sodium, 

intake to 2,000 milligrams. They 

should limit frozen foods and trips 

to fast food restaurants. They 

should read nutrition labels on 

packaged foods to learn how much 

sodium is in one serving. Keeping 

a sodium diary can help monitor 

sodium intake. 

•	 get plenty of exercise—at least 

30 minutes of moderate activity, 

such as walking, cycling, or swimming, most days of the week. 

•	 avoid consuming too much alcohol. 

Men should have no more than 

two drinks—two 12-ounce servings 

of beer or two 5-ounce servings 

of wine or two 1.5-ounce servings 

of hard liquor—a day. Women 

should have no more than a single 

serving a day because differences 

in the way foods are broken down 

in the body make women more 

sensitive to the effects of alcohol. 

Can medicines help control 

blood pressure? 

Many people need medicine to control 

high blood pressure. Several effective 

blood pressure medicines are available. 

The most common types of blood pressure 

medicines doctors prescribe are diuretics, 

angiotensin-converting enzyme (ACE) 

inhibitors, angiotensin receptor blockers 

(ARBs), beta blockers, and calcium channel blockers. Two of these medicines, the 

ACE inhibitors and ARBs, have an added 

protective effect on the kidneys. Studies have shown that ACE inhibitors and 

ARBs reduce proteinuria and slow the 

progression of kidney damage. Diuretics, 

also known as “water pills,” help a person urinate and get rid of excess fluid in 

the body. A combination of two or more 

blood pressure medicines may be needed 

to keep blood pressure below 130/80. 

Who is at risk for kidney 

failure related to high 

blood pressure? 

Everyone has some risk of developing 

kidney failure from high blood pressure. 

African Americans, however, are more 

likely than Caucasians to have high 

blood pressure and its related kidney 

problems—even when their blood 

pressure is only mildly elevated. In 

fact, African Americans are six times 

more likely than Caucasians to develop 

hypertension-related kidney failure.2 

2

United States Renal Data System. USRDS 2007 

Annual Data Report. Bethesda, MD: National Institute 

of Diabetes and Digestive and Kidney Diseases, 

National Institutes of Health, U.S. Department of 

Health and Human Services; 2007. 

3	 High Blood Pressure and Kidney Disease 
 

People with diabetes also have a greater 

risk of developing kidney failure. Early 

management of high blood pressure is 

especially important for African Americans with diabetes. 

The National Institute of Diabetes and 

Digestive and Kidney Diseases (NIDDK), 

also part of the NIH, sponsored the African American Study of Kidney Disease 

and Hypertension (AASK) to find effective ways to prevent high blood pressure 

and kidney failure in this population. The 

results, published in the November 20, 

2002, issue of the Journal of the American 

Medical Association, showed that an ACE 

inhibitor was the most effective drug at 

slowing the progression of kidney disease in African Americans. While ACE 

inhibitors help reduce the risk of kidney 

disease, they are less effective in lowering 

blood pressure in African Americans than 

in Caucasians. 

Points to Remember 

•	 Every year, high blood pressure 

causes more than 25,000 new cases of 

kidney failure in the United States. 

•	 Chronic kidney disease (CKD) is 

present when the estimated glomerular filtration rate (eGFR) is below 

60 milliliters per minute (mL/min). 

•	 More than 30 milligrams of albumin 

per gram of creatinine in a urine 

sample is another sign of CKD. 

•	 People with CKD should try to keep 

their blood pressure below 130/80. 

•	 Two groups of medicines called 

angiotensin-converting enzyme 

(ACE) inhibitors and angiotensin 

receptor blockers (ARBs) lower 

blood pressure and have an added 

protective effect on the kidneys. 

•	 African Americans are six times more 

likely than Caucasians to develop 

hypertension-related kidney failure. 

•	 Early management of high blood 

pressure is especially important for 

African Americans with diabetes. 

4 High Blood Pressure and Kidney Disease 
 

 

 

 

 

 

 

 

 

 

 

Hope through Research 

In recent years, researchers have learned 

a great deal about kidney disease. The 

NIDDK sponsors several programs aimed 

at understanding kidney failure and finding 

treatments to stop its progression. 

The NIDDK’s Division of Kidney, 

Urologic, and Hematologic Diseases supports basic research into normal kidney 

function and the diseases that impair 

normal function, including diabetes, high 

blood pressure, glomerulonephritis, and 

polycystic kidney disease. 

Participants in clinical trials can play a 

more active role in their own health care, 

gain access to new research treatments 

before they are widely available, and help 

others by contributing to medical research. 

For information about current studies, visit 

www.ClinicalTrials.gov. 

For More Information 

American Kidney Fund 

6110 Executive Boulevard, Suite 1010 

Rockville, MD 20852 

Phone: 1–800–638–8299 

Email: helpline@kidneyfund.org 

Internet: www.kidneyfund.org 

National Heart, Lung, and Blood Institute 

Information Center 

P.O. Box 30105 

Bethesda, MD 20824–0105 

Phone: 301–592–8573 

Email: nhlbiinfo@nhlbi.nih.gov 

Internet: www.nhlbi.nih.gov 

National Kidney Foundation 

30 East 33rd Street 

New York, NY 10016 

Phone: 1–800–622–9010 or 212–889–2210 

Internet: www.kidney.org 

You may also find additional information about this 


topic by
 

• searching the NIDDK Reference Collection at 

www.catalog.niddk.nih.gov/resources 

• visiting MedlinePlus at www.medlineplus.gov 

This publication may contain information about medications. When prepared, this publication included 

the most current information available. For updates 

or for questions about any medications, contact 

the U.S. Food and Drug Administration toll-free at 

1–888–INFO–FDA (463–6332) or visit www.fda.gov. 

Consult your doctor for more information. 

5 High Blood Pressure and Kidney Disease 
National Kidney Disease 

Education Program 

3 Kidney Information Way 

Bethesda, MD 20892 

Phone: 1–866–4–KIDNEY (454–3639) 

TTY: 1–866–569–1162 

Fax: 301–402–8182 

Email: nkdep@info.niddk.nih.gov 

Internet: www.nkdep.nih.gov 

The National Kidney Disease Education 

Program (NKDEP) is an initiative of the 

National Institute of Diabetes and Digestive 

and Kidney Diseases, National Institutes 

of Health, U.S. Department of Health and 

Human Services. The NKDEP aims to raise 

awareness of the seriousness of kidney disease, 

the importance of testing those at high risk, and 

the availability of treatment to prevent or slow 

kidney disease. 

National Kidney and 

Urologic Diseases 

Information Clearinghouse 

3 Information Way 

Bethesda, MD 20892–3580 

Phone: 1–800–891–5390 

TTY: 1–866–569–1162 

Fax: 703–738–4929 

Email: nkudic@info.niddk.nih.gov 

Internet: www.kidney.niddk.nih.gov 

The National Kidney and Urologic Diseases 

Information Clearinghouse (NKUDIC) is a 

service of the National Institute of Diabetes 

and Digestive and Kidney Diseases (NIDDK). 

The NIDDK is part of the National Institutes 

of Health of the U.S. Department of Health 

and Human Services. Established in 1987, the 

Clearinghouse provides information about 

diseases of the kidneys and urologic system to 

people with kidney and urologic disorders and 

to their families, health care professionals, and 

the public. The NKUDIC answers inquiries, 

develops and distributes publications, and works 

closely with professional and patient organizations and Government agencies to coordinate 

resources about kidney and urologic diseases. 

Publications produced by the Clearinghouse 

are carefully reviewed by both NIDDK scientists and outside experts. This publication was 

originally reviewed by Vito M. Campese, M.D., 

University of Southern California, and Matthew 

Weir, M.D., University of Maryland. The 2008 

version of this publication was reviewed by Eduardo Ortiz, M.D., National Heart, Lung, and 

Blood Institute. 

This publication is not copyrighted. The Clearinghouse encourages users of this fact sheet to duplicate 

and distribute as many copies as desired. 

This fact sheet is also available at 

www.kidney.niddk.nih.gov. 

U.S. DEPARTMENT OF HEALTH 

AND HUMAN SERVICES 

National Institutes of Health 

NIH Publication No. 08–4572 

July 2008