Changes to high blood pressure care that help protect your kidneys

High blood pressure (also called hypertension) can be both a cause and a result of kidney disease. Unfortunately, the death rate from hypertensive kidney disease in the U.S. increased 48% over the past 25 years, according to research presented in September at the American Heart Association's (AHA) Hypertension Scientific Sessions. This study also showed that the rate was higher than average for men, people living in the South and Black or Hispanic/Latino adults.

As part of their work to ensure clinicians are informed on current knowledge in the field of high blood pressure, the Heart Association and the American College of Cardiology released a new blood pressure guideline in August. This guideline is used by health care professionals to make care decisions for their patients. The 2025 guideline replaces the previous one, which was issued in 2017.

The guideline covers recommendations for a wide range of blood pressure-related conditions, including the newfound connections to brain health and dementia as well as high blood pressure in pregnancy. 

For adults living with kidney disease, here are four key takeaways from the new guideline:

1. Use the American Heart Association PREVENT™ equations 

The new guideline recommends that health care professionals use the American Heart Association Predicting Risk of cardiovascular disease EVENTs (PREVENT™) equations, which AHA created in 2023. The PREVENT calculator, based on the PREVENT equations, takes a variety of factors about a person (age, sex, blood pressure, cholesterol levels) as well as an optional social factor (zip code) to then determine how at-risk an adult is of having a heart attack, stroke or heart failure in the next 10-30 years. According to AHA, it is the first risk calculator that combines measures of cardiovascular, kidney and metabolic health to estimate risk for cardiovascular disease. 

2. The uACR test is now recommended for all adults with high blood pressure.

The ratio of urine albumin and creatinine (uACR) test is one of the tests used to evaluate a person's kidney function. In the 2017 guideline, it was only an optional recommendation for people with high blood pressure to help monitor kidney disease progression. Now, uACR is included in the recommended laboratory tests to determine CVD risk and inform management decisions. 

3. Kidney disease or diabetes as indicators to start medicine to lower blood pressure.

It is recommended that if an adult has high blood pressure and diabetes or kidney disease or is at increased risk of developing heart disease (based on their PREVENT risk estimate), they should start medicine to lower blood pressure — even if they do not have heart disease to decrease heart disease risk and delay progression of kidney disease. 

4. Kidney disease as indicator to start ACE inhibitors or ARBs.

For adults living with high blood pressure and kidney disease, the new guideline recommends starting angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), and that these medicines should also be considered when mild albuminuria (protein in the urine) is present. ACE inhibitors and ARBs are medicines that help control blood pressure by making blood vessels relax so blood can flow more easily. Compared with the 2017 guideline, the new guideline places stronger emphasis on using these medications across a wider range of kidney disease, including when smaller amounts of protein are present in the urine.

The connection between kidney disease and cardiovascular (heart) disease are two parts of a health condition called cardiovascular-kidney-metabolic (CKM) syndrome. Defined in a 2023 AHA presidential advisory, CKM is a health condition made up of heart disease, kidney disease, diabetes and obesity, leading to poor health outcomes. AHA estimates that 9 out of 10 U.S. adults have not heard of the condition, even though approximately 90% of people have at least one of the risk factors.

To help raise awareness and knowledge of CKM syndrome, AKF is honored to be a collaborator of the AHA's Cardiovascular-Kidney-Metabolic Health Initiative™.

Learn more about CKM syndrome or the connection between high blood pressure and kidney disease on our website. You can also download our free guide for monitoring your blood pressure at home.