As the north wind blows, blood pressure soars, kidney patients are busy controlling blood pressure

The cold wind is blowing, and the temperature is dropping like a dive. Winter is coming again. How is your blood pressure? Recently, kidney patients have frequently complained that "the temperature is dropping, blood pressure is rising, blood pressure is difficult to adjust, and it is troublesome".

Causes of blood pressure fluctuations in autumn and winter

1. Temperature changes

The trend of changes in human blood pressure has obvious seasonality, usually showing "high in autumn and winter, low in spring and summer", mainly due to temperature changes. In autumn and winter, the temperature drops, and the human body is stimulated by low temperature, and the small blood vessels in the skin and internal organs contract, and the peripheral vascular resistance increases. At the same time, the sympathetic nerves are excited, and the secretion of norepinephrine increases, leading to increased blood pressure. Studies have found that for every 1°C drop in outside temperature, systolic blood pressure increases by 0.26 mmHg, and for every 1°C drop in indoor temperature, systolic blood pressure increases by 0.38 mmHg. Therefore, compared with the hot summer, the increase in systolic blood pressure in winter can reach an average of 8-10 mmHg.

2. Shorter sunshine hours and less vitamin D

In winter, daylight hours are shortened, ultraviolet light intensity decreases, and the body's synthesis of vitamin D decreases, which may activate the renin-angiotensin-aldosterone system and cause blood pressure to rise. The decrease in vitamin D in winter can also cause increased secretion of parathyroid hormone, stimulating the growth of vascular smooth muscle and thereby enhancing vascular contractility, causing blood pressure to increase.

3. Changes in lifestyle habits

Our country has a tradition of emphasizing "harvesting in autumn and storing in winter". In cold weather, people are more likely to eat high-calorie, high-fat foods and spend less time outdoors. Reduced activity and changes in weight will also lead to higher blood pressure.

How to adjust blood pressure fluctuations

Studies have shown that seasonal changes in blood pressure are significantly correlated with the incidence and death of cardiovascular diseases in hypertensive patients. For kidney patients, large fluctuations in blood pressure will also accelerate the progression of kidney disease. Therefore, kidney patients cannot turn a blind eye to such blood pressure fluctuations.

1. Maintain a healthy lifestyle

A low-salt diet, weight control, moderate exercise, quitting smoking and drinking, and keeping a relaxed mood are the first steps in blood pressure management, which is even more important for patients with kidney disease. Pay attention to keeping warm, listen to the weather forecast in time, add or remove clothes according to the temperature, and do aerobic exercise outdoors in sunny weather, preferably in the afternoon or evening, and avoid going out in cold weather.

2. Strengthen blood pressure monitoring

When blood pressure fluctuates greatly and medication is adjusted, it is especially important to monitor blood pressure at home, measure blood pressure every morning and evening, and record it carefully. At the same time, regular 24-hour dynamic blood pressure monitoring is required to timely understand the increase in blood pressure at night. This helps patients understand their own blood pressure fluctuations and facilitates doctors to adjust antihypertensive drugs.

3.Flexible adjustment of antihypertensive drugs

For patients with kidney disease and hypertension, the overall blood pressure reduction target is blood pressure below 140/90 mmHg. For patients with 24-hour urine albumin < 30 mg/24 h, it is recommended to control blood pressure < 140/90 mmHg, and for patients with 24-hour urine albumin ≥ 30 mg/24 h, it is recommended to control blood pressure < 130/80 mmHg. When blood pressure fluctuates too much, you need to see a doctor in time, and the doctor will adjust the medication according to the blood pressure measurement records and the condition of the kidney disease.

References

1. Li Xinyu, Yang Ning. Research progress on seasonal changes of blood pressure[J]. Chinese Journal of Hypertension, 2022, 30(9): 826-829. DOI: 10.16439/j.issn.1673-7245.2022.09.007

2.Cheung AK, Chang TI, Cushman WC, et al. Executive summary of the KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease[ J]. Kidney Int, 2021, 99(3): 559-569. DOI: 10.1016/j.kint.2020.10.026

3. Expert Group of the Chinese Society of Nephrology. Guidelines for the Management of Hypertension in Chronic Kidney Disease Patients in China (2023 Edition). Chinese Journal of Nephrology, 2023, 39(01):48-80. DOI:10.3760/cma.j.cn441217-20220630-00650