• High blood pressure is also known as hypertension.
• About 5 in every 10 people with ADPKD have high blood pressure.
• It might be the first sign that you have ADPKD.
• High blood pressure can be lowered with lifestyle changes (such as a healthy diet and exercise) and medication.
• It’s not clear whether lowering your blood pressure can slow the speed at which ADPKD damages your kidneys.
• However, keeping your blood pressure in a healthy range has other benefits — it reduces your risk of a heart or circulatory condition (cardiovascular disease).

Blood pressure is the pressure of blood inside your arteries. Your arteries are blood vessels that carry blood from your heart all around your body. The higher your blood pressure, the harder your heart needs to work to pump your blood. This is the same principle that makes it harder to pump air into a bike tyre as it becomes more inflated.

Blood pressure is measured in millimetres of mercury (mmHg) and is written as two numbers, such as 120/80 mmHg:

• The first (top) number is your ‘systolic blood pressure’. This is measured as your heart beats and is the highest pressure your blood reaches.
• The second (bottom) number is your ‘diastolic blood pressure’. This is measured when your heart relaxes between beats and is the lowest pressure.

So, if your systolic blood pressure is 120 mmHg and your diastolic blood pressure is 80 mmHg, your blood pressure is said to be ‘120 over 80’, written as 120/80 mmHg.

If you’re an adult, your doctor will diagnose you with high blood pressure (hypertension) if your blood pressure is:

• 140/90 mmHg or higher when measured more than once in the clinic
• 135/85 mmHg or higher, on average, when measured continually throughout the daytime

Your doctor might even count blood pressure of over 130/85 mmHg as high blood pressure.

We explain how blood pressure measurements are done later (see How is blood pressure diagnosed?). 

Diagnosing high blood pressure in children is done differently. Children are diagnosed with high blood pressure if their systolic or diastolic blood pressure is high compared with the usual range for their age, height and sex.

About 5 in every 10 people with ADPKD have high blood pressure. This makes it about twice as common in people with ADPKD compared with the general population.

Only 1 in every 10 children with ADPKD have high blood pressure. However, many more people develop it in adulthood, at an average age of 30 years old. Risk increases with age — most people with ADPKD over 50 years old have high blood pressure.

Some people with ADPKD have higher than normal blood pressure only when they sleep. For example, although only 1 in 10 children with ADPKD have high blood pressure throughout the day, over 3 in 10 get night-time increases in blood pressure.

You might get high blood pressure before you have any other signs of ADPKD. This might be spotted at a routine check-up.

Once you have kidney symptoms of ADPKD, you’re very likely to have high blood pressure.

High blood pressure can damage the kidneys. So, while high blood pressure can be caused by ADPKD, it may also worsen ADPKD.

Having high blood pressure means that your heart must work harder to pump blood around your body. This can strain your heart as well as other organs and your blood vessels.

Problems can include:

• an increased risk of having a blood clot or bleed on the brain (stroke)
• reduced blood flow to the heart (coronary heart disease), which can increase your risk of having a heart attack
• thickening of an area of the heart (left ventricular hypertrophy), which can increase your risk of having an irregular heartbeat and heart failure
• sexual problems, such as difficulty keeping an erection for men

If your blood pressure is extremely high, it could also affect your ability to drive (as it can alter your vision).

We explain more about these problems later on this web page.

We understand that it can be worrying to read that you could be at risk of a heart problem or stroke. If reading this information has caused you worry or you have any questions, please contact our helpline on 0300 111 1234 for support.

The risk of having a heart or circulatory condition (known as cardiovascular disease) differs between people. Your risk depends on your blood pressure and also:

• your age
• your sex (risk is higher for men than women)
• whether you smoke
• your cholesterol level
• your weight
• how much you exercise
• if you have other health conditions, for example diabetes
• if you have any heart and artery problems
• whether other people in your family have had cardiovascular disease
• your kidney function

The good news is that your risk of cardiovascular disease can be reduced with treatment to lower your blood pressure and other medicines. We explain these later.

Most people with high blood pressure have no symptoms. It’s spotted and diagnosed through blood pressure checks. This is why blood pressure checks are recommended for people with ADPKD.

Most people with ADPKD have their blood pressure measured when they go to their kidney clinic for a check-up. This is usually done at least once a year. Experts recommend that children with ADPKD (or at risk of ADPKD) have their blood pressure monitored at least every 2 years from age 5 years.

You might also have your blood pressure checked when you visit the GP or pharmacist. Your doctor might suggest you monitor your blood pressure at home too.

Because there’s a chance that children will only have high blood pressure during the night, your child’s doctor might suggest using a device to measure their blood pressure over 24 hours (see 24-hour blood pressure monitoring below).

Adults who haven’t been diagnosed with ADPKD but who are at risk can choose to have their blood pressure checked. This is normally done at least once every 3 years. Blood pressure checks are routine for anyone over 40 years old.

Blood pressure is usually checked at the doctor’s or a hospital clinic. However, you might be able to do measurements at home too.

If you’re having a blood pressure check face to face, the doctor or nurse will use a blood pressure monitor. This is a small machine with an arm cuff.

To make the reading as accurate as possible, it’s important to prepare beforehand.

This includes:

• not having caffeine, exercising or smoking for 30 minutes
• having a pee
• relaxing without talking in a chair for at least 5 minutes

Your blood pressure reading might be higher than normal if you don’t do these things or if seeing the doctor makes you nervous (this is sometimes called ‘white coat hypertension’).

If readings show your blood pressure is high, your doctor will probably suggest monitoring your blood pressure over 24 hours. This is called 24-hour blood pressure monitoring.

24-hour blood pressure monitoring

This monitoring is used to confirm that you have high blood pressure. It checks how high your blood pressure is throughout your day-to-day life. You’ll wear a small machine that measures your blood pressure over 24 hours while you go about your usual life. You strap the monitor around your waist and the cuff around your upper arm. The cuff inflates and deflates automatically many times over 24 hours to record your blood pressure.

It’s normal for our blood pressure to lower while we sleep. In some people with ADPKD this doesn’t happen, even if their daytime blood pressure is normal. 24-hour blood pressure monitoring can spot these night-time increases in blood pressure.

Home blood pressure monitoring

If 24-hour blood pressure monitoring is not suitable for you, your doctor might lend you a blood pressure machine to take your own readings throughout the day. This is called home blood pressure monitoring.

You should take your blood pressure at the same times each day. Prepare in the same way that you would for a blood pressure check at the doctors (see above). See the British Heart Foundation website for more advice on how to measure your blood pressure at home.

If you’re using a blood pressure monitor at home, make sure you have a cuff the right size for your arm.

Extra tests

If you’re found to have high blood pressure, your doctor might offer you a urine test, blood test, eye test and electrocardiogram (ECG) of your heart. These tests check for problems that high blood pressure can cause.

Your doctor will also calculate your risk of having cardiovascular problems and explain this to you.

If you have high blood pressure, your doctor will work with you to reduce it to a safer level. This is done through lifestyle changes, such as diet and exercise. You might need medications too.

You and your doctor will agree on a target blood pressure together, taking into account:

• your age
• your risk of cardiovascular disease
• your kidney function
• any other health conditions you have
• what lifestyle changes you can maintain long term
• whether blood pressure medicines cause you any difficult side effects

Depending on these things, your target is likely to be below 130/90 mmHg or below 120/80 mmHg.

If you have good kidney function and are aged 18 to 49, your doctor might suggest an even lower target, such as under 110/75 mmHg. However, if your blood pressure dips too low you might get dizzy and tired more often — speak to your doctor if this happens.

Blood pressure targets in children are based on what is normal for their age, sex and height.

If you have high blood pressure, your doctor will work with you to reduce it to a safer level. This is done through lifestyle changes, such as diet and exercise. You might need medications too.

You and your doctor will agree on a target blood pressure together, taking into account:

• your age
• your risk of cardiovascular disease
• your kidney function
• any other health conditions you have
• what lifestyle changes you can maintain long term
• whether blood pressure medicines cause you any difficult side effects

Depending on these things, your target is likely to be below 130/90 mmHg or below 120/80 mmHg.

If you have good kidney function and are aged 18 to 49, your doctor might suggest an even lower target, such as under 110/75 mmHg. However, if your blood pressure dips too low you might get dizzy and tired more often — speak to your doctor if this happens.

Blood pressure targets in children are based on what is normal for their age, sex and height.

These steps can help you lower your blood pressure and reduce your risk of having a cardiovascular problem:

• Lose any excess weight (the recommended body mass index for most adults is 18.5 to 24.9 kg/m²).
• Exercise regularly.
• Eat a healthy balanced diet.
• Do not add salt to your food and eat no more than 5g of salt a day (which is the same as 2g of sodium). Check food labels.
• Drink 2–3 litres of water a day (unless you have poor kidney function — see below).
• If you drink a lot of caffeine (coffee, tea, cola, energy drinks), cut this down.
• Give up smoking.
• If you drink a lot of alcohol, cut this down (guidelines suggest 14 units or less per week for men and women).

Experts recommend that people with ADPKD drink at least 2–3 litres of water a day, provided their estimated glomerular filtration rate (eGFR) is at least 30 ml/min/1.72 m². If your eGFR is lower than 30 ml/min/1.72 m² (meaning you have chronic kidney disease stage 4 or 5), please follow your kidney specialist’s advice about water. If you aren’t sure what your eGFR is, ask your doctor.

You’ll find more detailed information and tips on a healthy diet and lifestyle on our website.

Medications to lower blood pressure

If you have high blood pressure and ADPKD, your doctor should discuss options for medication with you. Medications to reduce blood pressure are known as antihypertensive drugs. For people with ADPKD, one medicine is usually enough to control blood pressure, but some people need multiple medicines.

Your doctor will probably recommend either an angiotensin-converting enzyme (ACE) inhibitor or angiotensin-II receptor blocker (ARB) unless there is a reason you can’t take these.

• ACE inhibitors have names ending in ‘pril’ (for example ramipril, lisinopril, and perindopril).
• ARBs have names ending in ‘sartan’ (for example, candesartan, losartan, valsartan and irbesartan).

A common side effect of these medicines is that your blood pressure can become too low. This is called hypotension and can make you feel tired or dizzy and lightheaded, especially when you stand up. Some people get a persistent dry cough with ACE inhibitors, and some people get a headache or fatigue with ARBs.

Serious side effects are uncommon. Ask your doctor for more information to help you decide together which medicine might be best for you.

If your ACE inhibitor or ARB is not controlling your blood pressure well, your doctor may suggest trying a different medicine called aliskiren or a beta blocker. These medicines also help to control blood pressure. Alternatively, your doctor might suggest trying a calcium channel blocker.

These medicines can have side effects, for example:

• Aliskiren can cause dizziness (hypotension), diarrhoea and joint pain.
• Beta blockers can cause fatigue and difficulty getting or keeping an erection.
• Calcium channel blockers can cause dizziness (hypotension), ankle swelling, flushing, palpitations (when you can feel your heart pound), and constipation.

Serious side effects are uncommon. Ask your doctor for more information to help you decide together which medicine might be best for you.

Some people with ADPKD take a diuretic as well as an ACE inhibitor or ARB. Diuretics are tablets that encourage your kidneys to take excess water from your blood and turn it into pee. If you’re taking both, you’ll have extra monitoring of your kidney function as there’s a greater chance it will be affected.

Whichever blood pressure medicine you’re taking, read through the package leaflet so you know what side effects to look out for. Talk to your doctor if you have any side effects. There are many medications to lower blood pressure, so you might be able to swap or lower the dose.

Your doctor will let you know if there are times you should stop taking your blood pressure medicine (for example, if you’re ill or are about to have surgery).

Additional medicines to reduce cardiovascular risks

Some medicines, such as ARBs and ACE inhibitors, can help to protect you against cardiovascular problems as well as lower your blood pressure.

If you’re at high risk of having a cardiovascular problem, your doctor might recommend you take additional medicines.

These include:

• lipid-lowering drugs (statins) to reduce your cholesterol
• antiplatelet drugs (such as aspirin or clopidogrel) to reduce your risk of a stroke or heart attack

Your doctor will explain why these might help you and will talk you through the risks and benefits.

Vision and driving

If your blood pressure is above 180/100 mmHg, you should not drive until a doctor confirms your blood pressure has reduced and is well controlled. This is because very high blood pressure can affect your vision. See Gov.uk for more information about this.

If you notice your vision has worsened (for example when watching TV or reading), see an optician. If they think you could have eye damage caused by high blood pressure, they’ll advise you to see a doctor or other specialist.

ACE inhibitors and ARBs reduce the amount of a hormone called angiotensin II in your body or stop angiotensin II working.

Angiotensin II can increase blood pressure in a number of ways:

• making blood vessels tighter
• keeping more water in the blood (by reducing the amount the kidneys take out)

By blocking angiotensin II, ACE inhibitors and ARBs reduce your blood pressure.

Other blood pressure medicines work in different ways. For example, beta blockers work by slowing your heart rate, relaxing your blood vessels, and reducing levels of angiotensin II.

Because blood pressure medicines work in different ways, it can be helpful to take more than one type to get your blood pressure under control. You’ll only need to do this if one medicine is not working well enough.

To keep your blood pressure at a healthy level, you’ll need to continue your healthy lifestyle and your prescribed medicines. You’ll have yearly blood pressure checks. If your blood pressure is not well controlled, your doctor can recommend different or additional medicines for you.

Some people like to check their blood pressure themselves. While you should not rely on this instead of having checks with your doctor, it can be helpful to put your mind at ease. Your kidney specialist or GP might suggest home monitoring, and some chemists offer free blood pressure checks. If you buy a blood pressure monitor, make sure it’s one approved by the British and Irish Hypertension Society (BHIS).

If you’re using a blood pressure monitor at home, make sure the cuff is the right size for your arm and prepare properly (see Checks at the clinic).

Why does ADPKD increase blood pressure?

There are a number of ways ADPKD might affect blood pressure, but we still have more to learn.

ADPKD might:

• increase the activity of hormones that control blood pressure (such as angiotensin II)
• increase the amount of blood in blood vessels
• cause blood vessels to tighten and narrow

In combination, these effects can mean there is more blood with less room to travel, increasing blood pressure. You could think of it like a motorway where a lane has been closed — the traffic becomes busier as it fights for space.

There are a number of theories as to why ADPKD increases angiotensin II. For example, kidney cysts can squash tiny vessels in the kidney, making it harder for blood to flow through them. This can lead to hormone levels rising as the body tries to get more blood to the area.

High blood pressure tends to worsen as kidney cysts grow and the kidneys enlarge.

More information on the health problems that high blood pressure can cause

We understand that it can be worrying to read that you could be at risk of a heart problem or stroke. If the information below causes you worry or you have any questions, please contact our helpline on 0300 111 1234 for support.

Stroke

A stroke is damage to the brain caused by either:

• a blood clot that blocks blood flow in the brain (an ischaemic stroke)
• bleeding from a blood vessel in the brain (a brain haemorrhage)

People with high blood pressure are more likely to have a stroke than people with normal blood pressure. This is true for people with and without ADPKD.

Added to this, people with ADPKD are at greater risk of a stroke caused by bleeding from a brain aneurysm. A brain aneurysm is a bulge in a blood vessel in the brain. See our web page on brain aneurysms to learn more.

There are ways to reduce your risk of stroke:

• Reduce your blood pressure if it’s high (see How is high blood pressure treated?).
• If you’re at risk of having a brain aneurysm, you can have a scan to check for one. Ask your doctor or kidney specialist for more information.
• If you have a brain aneurysm and doctors think there’s a risk of it bursting, you can have a procedure to treat it.

We explain these scans and treatments on our web page on brain aneurysms.

While strokes can be dangerous, most strokes are not fatal in people with ADPKD. Treatments are available — the earlier they are started the better.

Everyone, whether or not they have ADPKD, should be aware of the signs of a stroke or bleed on the brain:

• face weakness — one side of the face drooping or it being hard to smile
• arm weakness — being unable to fully lift both arms
• speech problems — slurring words or sounding confused
• an incredibly severe headache that comes on in under a minute

If you or someone else gets these symptoms, call 999 for an ambulance.

Coronary heart disease

Coronary heart disease happens when the blood supply to the heart is reduced. It’s also called ischaemic heart disease or coronary artery disease. The proportion of people with ADPKD who have coronary heart disease is thought to be higher than the general population. However, the exact numbers are unknown.

Symptoms of coronary heart disease include:

• chest pain
• shortness of breath
• pain in the neck, shoulders, arms or jaw
• feeling faint
• feeling sick

If the blood supply to the heart becomes badly blocked, this can cause a heart attack (a myocardial infarction). Heart attacks are about twice as common in people with ADPKD compared with people without the condition. The risk is thought to be greater in people who have high blood pressure.

A heart attack is life-threatening and requires emergency treatment. Symptoms of a heart attack include chest pain (which is often severe), overwhelming anxiety, and the symptoms of coronary heart disease listed above. If you or someone else gets these symptoms, call 999 for an ambulance.

There are steps you can take to reduce your risk of coronary heart disease and a heart attack. These include:

• a healthy diet and lifestyle
• taking medicines to reduce your blood pressure, if it’s high

For more information, see How is high blood pressure treated? above.

If you have coronary heart disease, a heart specialist (cardiologist) will help you to manage the condition and reduce your risk of a heart attack. If your heart’s blood supply is getting too low, they may suggest surgery or a procedure to widen the blood vessels in your heart.

The British Heart Foundation has information on these procedures.

Left ventricular hypertrophy

Untreated high blood pressure can cause changes to the heart due to the extra effort it’s making. A common change is called left ventricular hypertrophy. In this condition, the main area of the heart that pumps blood (the left ventricle) has a thicker wall than usual. This makes it harder for the heart to pump blood.

If you have high blood pressure, your doctor might recommend you have an echocardiogram to check for left ventricular hypertrophy. An echocardiogram uses sound waves to look at your heart.

The proportion of people with ADPKD who have left ventricular hypertrophy has fallen now that blood pressure is generally better controlled. However, it still occurs in at least 4 in 100 adults with ADPKD.

Left ventricular hypertrophy can increase your risk of having an irregular heartbeat (arrhythmia) and heart failure. In heart failure, the heart can’t pump enough blood around your body to meet its needs. This makes you tired and out of breath, and it can worsen over time. Heart failure is not the same as a heart attack.

If you have left ventricular hypertrophy, a heart specialist (cardiologist) will help you to manage the condition and reduce your risk of heart failure. This can include taking medicine to control your blood pressure, following a healthy lifestyle, and possibly taking other medicines.

Sexual problems

In men, high blood pressure and some medicines to treat high blood pressure can cause problems getting or keeping an erection (erectile dysfunction). About 4 in every 10 men over the age of 40 sometimes get erectile dysfunction. High blood pressure can make the problem worse.

High blood pressure can cause erectile dysfunction due to:

• damage to blood vessels in the penis causing them to harden and narrow
• side effects of medicines such as beta-blockers and diuretics

High blood pressure can also affect ejaculation and sex drive in men.

The effects of high blood pressure in women are not well understood, but it might cause:

• lower sex drive or arousal
• difficulty having an orgasm
• a dry vagina

If you’re having any sexual problems, talk to your doctor. They can talk you through treatments to help. You might be able to switch to a different blood pressure medicine if this might be the cause.

• Brain aneurysms 
• Diet and lifestyle
• ADPKD progression

The British Heart Foundation website and Blood Pressure Association website have information and advice on blood pressure, including information on blood pressure monitors.

British Heart Foundation website also has information on coronary heart disease, heart failure, heart attack, stroke, and other cardiovascular problems.

The Mayo Clinic website has information on how high blood pressure can affect sex (this page is written for people in the USA).

NHS website has a calculator for body mass index and tips on managing your weight.