The difference between hypertensive nephropathy and renal hypertension

Written by Zhou Qi
Nephrology
Updated on January 30, 2025
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Hypertensive nephropathy and hypertension due to kidney disease need to be differentiated, as this affects the treatment approach and prognosis assessment differently. Hypertensive nephropathy refers to patients with long-term high blood pressure, which causes arteriosclerosis of small vessels leading to renal pathology. Often, there is also arteriosclerosis in other organs, such as the retinal arteries, which can be confirmed through funduscopic examination. On the other hand, hypertension due to kidney disease occurs when a patient has kidney disease first followed by hypertension, where the causes and types of kidney diseases vary and can frequently lead to hypertension. The difference between the two lies in the sequence of occurrence. Hypertensive nephropathy is characterized by initial high blood pressure and commonly associated with arteriosclerosis in other vessels, which can be preliminarily identified through funduscopic examination. In cases of hypertension due to kidney disease, the patient has other kidney disorders first, followed by hypertension. If a patient's 24-hour urine protein quantification exceeds 2g, it is likely due to kidney disease rather than hypertensive nephropathy. If differentiation remains challenging, kidney biopsy can be performed for further differentiation.

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Written by Zhang Yue Mei
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What should be done at the start of hypertension?

What to do at the onset of hypertension, specifically refers to mild early-stage hypertension. Mild early-stage hypertension can be managed through reasonable dietary adjustments and increased physical activity to lower blood pressure to normal levels. Generally, it is not necessary to use antihypertensive medications. Aerobic exercises such as swimming, skipping rope, square dancing, playing table tennis, volleyball, tennis, can increase vascular elasticity and improve blood circulation, thereby achieving a blood pressure-lowering effect. In terms of diet, it is important to focus on low-fat, low-salt, and low-oil intake to reduce the occurrence of arteriosclerosis and decrease blood viscosity, as well as sodium and water retention which can cause elevated blood pressure. Pay attention to rest, avoid overworking, and do not get overly excited. These are effective treatment and prevention methods for initial mild hypertension.

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Written by Tang Li
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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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Written by Liu Ying
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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.)

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How is hypertensive nephropathy treated?

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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What is the blood pressure for gestational hypertension?

Pregnancy-induced hypertension refers to a series of pathophysiological changes caused by elevated blood pressure in women during pregnancy. It is a severe complication of pregnancy that can have serious effects on both the mother and the fetus. The diagnostic standard for hypertension during pregnancy is the same as in non-pregnant periods, that is, a blood pressure greater than 140/90mmHg can be diagnosed as pregnancy-induced hypertension. However, pregnancy-induced hypertension can be classified based on whether it is combined with other conditions, as well as the severity of the condition. Depending on the severity, pregnancy-induced hypertension can be divided into categories such as gestational hypertension, pre-eclampsia, eclampsia, chronic hypertension, and chronic hypertension with superimposed pre-eclampsia. These classifications are mainly based on the severity of the condition, and it is essential to treat pregnancy-induced hypertension with standardized care.