Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017, University of Virginia
Maria Luisa S. Sequeira-Lopez, MD, and R. Ariel Gomez, MD, of the University of Virginia School of Medicine, have found that an aggressive combination treatment for hypertension could cause kidney damage. Credit: Sanjay Suchak, University of Virginia

Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Researchers identified the potential problem while studying strange kidney lesions in mice that cannot make the enzyme renin. Such lesions are also seen in patients with high . The researchers determined the lesions are the work of renin cells, which are sometimes targeted in treating .

"To treat hypertension, people use inhibitors of the system," explained R. Ariel Gomez, MD, director of UVA's Child Health Research Center. "They've been in use for quite a bit now, and, for the most part, they're safe. Our work in mice indicates that complete lack of renin results in vascular lesions. The question is whether aggressive, long-term use of compounds that completely ablate the renin angiotensin system causes any problems in humans. Thus, additional research is needed."

Renin's Role in Managing Blood Pressure

Renin is a hormone the body produces to regulate blood . But renin-producing cells also play an important role in the formation of blood vessels during development in the womb. Blocking the cells from producing renin in adult mice, the researchers found, caused obstructive vascular lesions in the kidneys. It was as though the renin cells were trying to build blood vessels—only these were defective and nonfunctional, created by cells, the researchers found, that were disorganized and directionless. "Normal arteries are thin, and they allow blood to go through," Gomez said. "These are filled with these cells."

Researcher Maria Luisa S. Sequeira-Lopez, MD, said that the question now becomes whether stopping the cells from carrying out their intended function, especially over long periods of time, is having an unintended side effect in patients with high blood pressure. Renin inhibition, she noted, already is avoided during pregnancy because of its unwanted effects during development.

Questioning the Combination

It's important to note that Gomez and Sequeira-Lopez are concerned not about high-blood pressure drugs in general but specifically about the less common combination treatments that completely block the whole renin-angiotensin system and chronically stimulate renin cells to accumulate inappropriately and alter the kidney blood vessels. This, together with , can dramatically alter kidney structure. And they emphasize that patients should not stop taking their prescribed medications.

The next steps, they said, are to investigate their finding further, to better understand what is happening, and to see if it holds true in humans. "Is the secret to stop using these medications? No," Gomez said. "But we need to find out several things. First, whether it is necessary or not to use dual combinations of drugs that over-activate ... and also, how low and how fast should pressure be lowered. And then, after that, is to look at the effects this combination [treatment] has in individuals, in people."

If the findings ultimately hold true in humans, doctors will need to consider their next steps carefully. "If they do, do we get rid of these compounds? Not necessarily," Gomez said. "What we need to find out is, how does this happen? So we can understand what molecules are activated, and maybe act on those molecules and use lower doses to prevent the overgrowth of the vessels."

His final advice for physicians: "I think the most important thing is to have good judgment as a doctor and not to overdo it," he said, referring to aggressive treatment of hypertension using full-blown inhibition. "Learning this is useful, but we need to find out more."

Explore further: Probing the secrets of cell identity

More information: Masafumi Oka et al, Chronic Stimulation of Renin Cells Leads to Vascular PathologyNovelty and Significance, Hypertension (2017). DOI: 10.1161/HYPERTENSIONAHA.117.09283

Related Stories

Probing the secrets of cell identity

August 25, 2016
Though organisms have drastically evolved since climbing out of the primordial soup, one scientific fact has remained the same for epochs: cells are the most basic structural units of all living things.

Simple blood tests lead to improved hypertension treatment in African countries

May 2, 2017
Using two simple blood tests, Western University researchers were able to drastically improve treatment for resistant hypertension across three sites in Nigeria, Kenya and South Africa.

Researchers identify novel cell type that leads to aggressive leukemia

March 7, 2014
Researchers at the University of Virginia School of Medicine have discovered a specific type of immune cell in the bone marrow of mice responsible for an aggressive, poorly understood form of leukemia.

Recommended for you

People who walk just 35 minutes a day may have less severe strokes

September 19, 2018
People who participate in light to moderate physical activity, such as walking at least four hours a week or swimming two to three hours a week, may have less severe strokes than people who are physically inactive, according ...

Inflammation critical for preventing heart attacks and strokes, study reveals

September 19, 2018
Inflammation, long considered a dangerous contributor to atherosclerosis, actually plays an important role in preventing heart attacks and strokes, new research from the University of Virginia School of Medicine reveals.

Effective drug delivery to heart with tannic acid

September 18, 2018
Typical methods of drug delivery to the heart require surgical procedures involving incisions in the chest wall and bones. To efficiently treat cardiovascular and related vascular diseases without surgery, a KAIST research ...

Daily low-dose aspirin found to have no effect on healthy life span in older people

September 16, 2018
In a large clinical trial to determine the risks and benefits of daily low-dose aspirin in healthy older adults without previous cardiovascular events, aspirin did not prolong healthy, independent living (life free of dementia ...

Financial incentives for cholesterol control may be cost-effective

September 14, 2018
A program that offered financial incentives to both patients and their physicians to control low-density lipoproteins (LDL) cholesterol could be a cost-effective intervention for patients at high risk of cardiovascular disease ...

Apple's smartwatch has a heart monitor now

September 13, 2018
There will soon be another way to monitor your heart—from your wrist.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.