From the Guidelines
Hematuria and hypertension can be related in certain medical conditions, particularly those affecting the kidneys, and it is essential to seek medical attention if both symptoms occur together, as this combination may indicate serious underlying kidney problems requiring prompt diagnosis and treatment. The most significant connection between hematuria and hypertension is through kidney diseases, which can cause both symptoms simultaneously. Conditions like glomerulonephritis, polycystic kidney disease, and renal artery stenosis can damage the kidneys, leading to both hematuria and hypertension 1. Additionally, malignant hypertension (severely elevated blood pressure) can directly damage blood vessels in the kidneys, causing blood to leak into urine. Certain medications used to treat hypertension, particularly anticoagulants, may occasionally cause hematuria as a side effect.
Some key points to consider in the evaluation and management of patients with hematuria and hypertension include:
- Control of blood pressure and reduction of proteinuria are critical in preventing chronic kidney disease (CKD) progression 1
- Lifestyle interventions, such as reduced sodium intake, achieving a healthy body mass index, smoking cessation, and regular exercise, can help reduce proteinuria and alleviate CKD progression 1
- Good diabetes control, with a target hemoglobin A1c level of 7%, is also linked to reduction of proteinuria and alleviation of CKD progression 1
- The American College of Physicians recommends that providers reduce the indiscriminate use of urinalysis and specifically inquire about a history of visible (or even self-limited) hematuria as part of their routine review of systems 2
In patients with a negative initial evaluation of asymptomatic microscopic hematuria, consideration should be given to repeating urinalysis, voided urine cytology, and blood pressure determination at regular intervals, as the appearance of hematuria can precede the diagnosis of bladder cancer by many years 3. Immediate urologic reevaluation, with consideration of cystoscopy, cytology, or repeat imaging, should be performed if any signs of significant underlying disease occur, such as gross hematuria, abnormal urinary cytology, or irritative voiding symptoms in the absence of infection.
From the Research
Association between Hematuria and Hypertension
- There is no direct evidence in the provided studies that explicitly links hematuria (blood in urine) with hypertension (high blood pressure) 4, 5, 6, 7, 8.
- However, the studies suggest that hypertension is a common comorbidity in patients with chronic kidney disease (CKD), which can lead to hematuria 4, 5, 6, 7, 8.
- The relationship between hypertension and CKD is well-established, with hypertension being a risk factor for the progression of kidney disease 4, 5, 6, 7.
- The studies focus on the management of hypertension in patients with CKD, emphasizing the importance of blood pressure control to slow the progression of kidney disease 4, 5, 6, 7, 8.
Management of Hypertension in CKD
- The recommended blood pressure goal for patients with CKD is <130/80 mmHg 6.
- Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are recommended as first-line antihypertensive agents in patients with CKD 4, 5, 6.
- Lifestyle modifications, such as diet and exercise, are also important in managing hypertension in patients with CKD 7.
- Intensive hemodialysis has been shown to reduce blood pressure and the need for antihypertensive medications in patients with end-stage renal disease (ESRD) 8.