Teleneurology is More Than Just Stroke Care
High Blood Pressure Can Lead To Kidney Disease And Even Kidney Failure. Here's How To Get It Under Control.
© Vianney Le Caer/Invision/AP Tina Turner passed away on May 24, 2023, after several health complications including high blood pressure and kidney disease. Vianney Le Caer/Invision/AP In the months before her death, legendary singer Tina Turner opened up about her uncontrolled high blood pressure that led to a stroke and kidney disease.
The late singer, who died this week at age 83, received a kidney transplant from her husband in 2017. But in a testimonial published before her death, she wrote that she didn't know about the connection between her kidneys and blood pressure until it was too late.
"I can't remember ever getting an explanation about what high blood pressure means or how it affects the body," she said in an article for Show Your Kidneys Love, an international campaign for kidney health.
If left untreated, high blood pressure can have cascading effects throughout the body's circulatory system — including disastrous effects on the kidneys. According to the National Institutes of Health, high blood pressure causes blood vessels to narrow, reducing blood flow to organs such as the kidneys.
Without proper blood flow, the kidneys may not be able to do their job of removing excess fluid and waste from the body — and as that fluid builds up, blood pressure will only increase further. It's a dangerous cycle that can lead to kidney failure, but it's possible to intervene early.
High blood pressure can be treated with medicationAlmost half of the US adult population has high blood pressure, also known as hypertension. The American Heart Association estimates that more than 122 million people in the US are affected by high blood pressure, which can increase the risk of heart attack and stroke as well as kidney disease.
High blood pressure can be managed with medication and lifestyle changes, such as following a heart-healthy diet and staying active. If lifestyle changes aren't enough to lower your blood pressure, it is vital to take medication as prescribed.
However, hypertension sufferers might not understand the risks that come with not following a medication regimen. Turner wrote that for a while after she was diagnosed with high blood pressure in 1978, she thought of it as her "normal" and didn't attempt to control it.
"I put myself at great danger by refusing to accept the reality that I required daily medication for the rest of my life," she wrote on Instagram on March 9.
Know the signs of kidney diseaseHigh blood pressure is the second leading cause of chronic kidney disease and kidney failure in the US after diabetes, according to the National Institutes of Health.
People with high blood pressure or diabetes should take extra care to get their kidneys checked, as early stage kidney disease doesn't usually have symptoms. But as damage to the kidneys gets worse over time, chronic kidney disease may cause swelling in the arms, legs, and face.
Other possible symptoms of advanced chronic kidney disease include:
Severe kidney disease can lead to kidney failure, which may mean that a patient needs dialysis, or even a kidney transplant like Turner.
High Blood Pressure Plagues Many Black Americans. Combined With COVID, It's Catastrophic.
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DISTRICT HEIGHTS, Md. — Charles Thomas was unwell, but he had no time for rest.
He was on the cusp of a management promotion and a move to Florida to begin a new chapter that would alter his family's financial future and break the cycle of generational poverty.
Yet, as his family's prospects improved, concerns about his health grew.
Melanese Marr-Thomas talks about the photographs of her late husband, Charles Thomas, which decorate her living room wall Sept. 21 in District Heights, Md.
Wong Maye-E, Associated PressA severe bout of COVID-19 left the 52-year-old weak and in recovery for weeks. His wife, Melanese Marr-Thomas, worried he was pushing himself too hard to get back in the swing of things. Charles was a big man at 6 feet tall and 300 pounds. He struggled for years to get his weight under control.
Later in life, that struggle gave way to high blood pressure and a medley of medications.
In a nation plagued by high blood pressure, Black people are more likely to suffer from it — and so, in the time of COVID-19, they are more likely than white people to die. It's a stark reality. And it has played out in thousands of Black households that have lost mothers and fathers over the past three years, a distinct calamity within the many tragedies of the pandemic.
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It has devastated families like the Thomases of District Heights, Maryland.
Charles had an intense fear of hospitals, needles and doctors, partially because they had, in the past, brushed aside his concerns. He felt doctors were quick to blame any ailments solely on his weight, but slow to listen to his symptoms or examine other causes.
His family had recently found a Black doctor who, for the first time in his life, made Charles feel comfortable — and most importantly, heard.
"He knew he needed to take better care of himself so we were trying to change his diet and be more active," Melanese said. "His blood pressure was beginning to come down."
But then, COVID intervened.
A photograph of Melanese Marr-Thomas, center, with her children is displayed as her computer desktop background in her home in District Heights, Md.
Wong Maye-E, Associated PressA framed photo of Melanese Marr-Thomas kissing her late husband, Charles Thomas, during their wedding ceremony sits with other family photos Sept. 21 at their home in District Heights, Md.
Wong Maye-E, Associated PressBicycles that belonged to Charles Thomas sit in the backyard of his home in District Heights, Md.
Wong Maye-E, Associated PressEDITOR'S NOTE: This story is part of an AP series examining the health disparities experienced by Black Americans across a lifetime.
About 56% of Black adults have high blood pressure, compared to 48% of white people. Three in four African Americans are likely to develop the disorder by age 55.
When the force of your blood pushing against the walls of your blood vessels is consistently too high, it makes the heart and blood vessels work harder and less efficiently, which can lead to significant health issues.
While only 32% of white adults with high blood pressure have their condition under control with medication, the figure for Black Americans is even lower — 25%.
And it's likely to get worse: By 2060, the number of Americans battling cardiovascular disease is expected to drastically increase. High blood pressure rates alone are projected to rise 27.2%, or from roughly 127.8 million to 162.5 million Americans.
Among white people, the prevalence of cardiovascular risk factors and disease is projected to decrease over time. Yet significant increases are projected among people of color, especially Black and Latino Americans.
It is clear that high blood pressure has played a major role in COVID deaths, and especially in the COVID deaths of Black people. Together, high blood pressure and COVID have created a deadly combination: While high blood pressure is listed as a contributing factor in 15.5% of the deaths of white COVID sufferers, the figure for Black victims is 21.4% — the highest of any racial group.
Like many conditions, genetics do play a part. Experts also blame poor diets, high cholesterol, obesity and smoking — risk factors that often exist at higher rates in Black communities. In recent years, more academics and doctors have called attention to structural inequities.
The nation's health disparities have had a tragic impact: Over the past two decades, the higher mortality rate among Black Americans resulted in 1.6 million excess deaths compared to white Americans. That higher mortality rate resulted in a cumulative loss of more than 80 million years of life due to people dying young and billions of dollars in health care and lost opportunity.
"Until we reach health equity, these disparities are going to be a scar on the health care landscape in the United States," said Dr. Keith C. Ferdinand, the Gerald S. Berenson Endowed Chair in Preventive Cardiology at Tulane University's School of Medicine. He emphasized the importance of equal access to primary and specialty care and medications.
"If we don't do that, then we don't have a just society," Ferdinand said.
Melanese Marr-Thomas wears rubber bracelets in support of those who have lost a loved one to COVID, like herself, who lost her husband, Charles Thomas, in District Heights, Md.
Wong Maye-E, Associated PressCharles Thomas' infectious laugh could fill any room he entered. He also was a great storyteller. It's what made his wife, Melanese Marr-Thomas, fall in love with him decades ago when she was still a college student at Howard University in the late '90s.
When they met, the two quickly hit it off and could spend hours just talking. But they were in vastly different places in life: While Melanese was focused on her studies, Charles was trying to survive in a particularly tough Maryland neighborhood.
He eventually cut off all ties from her with little explanation.
"'You deserve so much more than what I can give,'" Melanese recalled Charles saying to her. "I was so hurt."
Years later, she found out it was because he was struggling to find his way out of a life of selling drugs.
Charles eventually had a son, Charles Thomas III, with another woman — a child whom Charles tried to be heavily involved in raising. But his street life eventually caught up with him.
Charles was incarcerated off and on for much of his son's childhood and teenage years.
"He was heavy in the streets," Charles Thomas III, 33, recalled. "But he made his presence known even when he was in jail. He would still find a way to send me gifts for Christmas."
It took years for Charles to eventually begin the hard journey of changing his life. Years later, he acknowledged the vicious cycle he found himself in. As a young Black man, he grew up poor and bounced around various communities that all suffered from the simmering effects of racism and segregation-era policies, with little hope and few pathways to escape poverty.
Eating healthy was hardly at the top of his mind, and largely out of reach. His neighborhoods were filled with fast food options, yet few grocery stores. And he was inundated with the toxic stress of living in a dangerous environment.
While in prison, Charles' health suffered, too.
It wasn't until his mother died while he was in prison that Charles felt a true spark to change.
Melanese Marr-Thomas reflects on memories of her late husband Charles Thomas, at home Sept. 21 in District Heights, Md.
Wong Maye-E, Associated Press"She was his backbone," Melanese said. "But after his mother passed, he had no sense of home and he said, 'I have to create my home and find my purpose and meaning.'"
Charles and Melanese reconnected in late 2009 and rekindled their romance. The couple eventually married and blended their families. He never shied away from talking about his earlier struggles in life. He acknowledged his mistakes and instead used it as a powerful way to teach his children to avoid the pitfalls he fell prey to.
"My dad, he was a great father to me and my best friend," said Charles Thomas III, who is now a teacher. "He taught me what I needed to know. He taught me how to be self-sufficient and stand on my own two feet. When he did things that were wrong, he never made excuses for it. He always told me the truth, so I never held anything against him."
Charles' family is what mattered most to him. And Black fatherhood was something that he cherished. He often spent long nights staying up with his kids and wife, reminiscing and sharing fatherly wisdom — sage advice they cling to today.
Melanese Marr-Thomas shows photographs of her late husband, Charles Thomas, at work.
Wong Maye-E, Associated PressHe worked his way up at his job as a concrete truck driver and became well respected in the company — and within his community, as a known father figure to other Black boys at his youngest son's football games. He launched a food truck and catering business, Sol Familia Mobile Kitchen, with his wife. Everything was looking up, finally.
But Charles Thomas began to feel sick around Thanksgiving in 2020. He thought it was a passing cold, but his wife was worried; the number of COVID cases was climbing, both nationally and locally, and the vaccine wasn't yet widely available.
Melanese was right. The entire family — parents and six children — would be diagnosed with COVID. But as the others got better, Charles' condition worsened.
His wife convinced him to go to the hospital, where his oxygen levels dropped severely and he spent eight days in the intensive care unit, where he was nearly placed on a ventilator. But he recovered, and went home in time for Christmas.
The family thought the worst was over.
Then Charles began having trouble breathing. The smallest tasks left him breathless and taking a few steps left him tired and struggling for air. Still, in late January 2021, he decided to go back to work.
She suspects Charles felt he still had to "make up" for time lost and his past mistakes.
The stress of it was toxic, and taxing on his health, and Melanese worried it exacerbated his high blood pressure — and also his COVID complications.
"I think that also killed him," Melanese said.
Melanese Marr-Thomas holds the fleece jacket of her late husband, Charles Thomas, which she still keeps in their coat rack at home Sept. 21 in District Heights, Md.
Wong Maye-E, Associated PressMore and more, researchers acknowledge that high blood pressure and other ailments that strike Black Americans disproportionately can, in great measure, be traced to the inequities of Black life in America.
Black Americans are more likely to live in communities that lack access to fruits and vegetables and other healthy foods. They're also more likely to live in communities inundated with fast food options that are often cheaper and easier to access but less healthy.
The same Black communities that experienced discriminatory housing policies more than 60 years ago are at a greater risk of heart disease and other related risk factors today, according to a July study in the Journal of the American College of Cardiology.
Residents of those neighborhoods also have less access to public transportation and health insurance. They also see lower life expectancies and higher incidence of chronic diseases that are risk factors for poor outcomes from COVID-19 — including high blood pressure.
Research is examining the effect of stress on high blood pressure rates in Black communities, according to Dr. Anika L. Hines, director of the Equity in Cardiovascular Health Outcomes Lab at Virginia Commonwealth University School of Medicine.
For Black Americans in particular, psychological stress — including discrimination or navigating racism — and its ensuing effects could be a precursor to high blood pressure, Hines said.
Historically, medicine has overlooked the role of structural barriers to good health among Black Americans. Instead, genetics, individual choice and even race have been blamed.
"As more people begin to embrace antiracism and accept race as a social construct and not as a biological construct, more attention will be paid to these social factors, psychosocial factors, cultural context, and history," Hines said.
Delmonte Jefferson, executive director of the Center for Black Health and Equity, said it's important to understand how health inequities that date back generations created today's conditions.
"This country has not, did not, does not at this point in time, value the health and well-being of people of color and so we keep having challenges with health and health disparities," Jefferson said.
Melanese Marr-Thomas looks at the vision board she created on the wall of her study room at home in District Heights, Md.
Wong Maye-E, Associated PressNear the end of February 2021, Charles Thomas' 16-year-old ran into the room one evening and shook Melanese awake. Something was wrong with Dad.
She rushed into the bedroom and found her husband on the floor on his hands and knees. He struggled to get up, but collapsed on the floor and stopped breathing.
Emergency responders performed CPR, but it was too late. Charles died Feb. 28, 2021, of COVID-19 related complications. He was 52.
So much was lost that night. The family was getting ready to move to Jacksonville, Florida. Charles had just been offered a job he spent 10 years working toward. He was slated to be a plant manager.
"I still relive that night," Melanese said. "He was the pillar of our family, the foundation, our protector. He was everything and it is an immeasurable loss."
Zachary Marr hugs his family's dog, Ryder, in their living room at home Sept. 21 in District Heights, Md.
Wong Maye-E, Associated PressSince Charles' death, the family has worked hard together — and in their own ways individually — to keep his memory alive.
For Melanese, that means cherishing his memory and their love.
"I'm spending my life reminding others that he was a husband, a father, a brother, an uncle, a nephew, a granddad, a co-worker and a friend to so many," Melanese said. "He was not a COVID number. He was a person who had hopes and dreams, aspirations."
For his namesake, Charles Thomas III, that means imparting love and wisdom to his own 5-year-old daughter, who his father adored. It also means supporting Melanese and helping her with his younger siblings.
"I can't look in the mirror without seeing my dad," he said. "When I go to school as teacher and I'm correcting my students, I see my dad. When I'm talking to my daughter and my girlfriend, I hear my father. Everything I say. I can hear him. He's going to live on through me."
Melanese Marr-Thomas hugs her youngest child, Savion Thomas, while her other son, Zachary Marr, shares a seat with their pet dog, Ryder.
Wong Maye-E, Associated PressKat Stafford, based in Detroit, is a national investigative race writer for the AP's Race and Ethnicity team. She was a 2022 Knight-Wallace Reporting Fellow at the University of Michigan. Follow her on Twitter: https://twitter.Com/kat__stafford.
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Tina Turner Had A History Of High Blood Pressure And Kidney Disease. Here's How One Leads To The Other
Legendary singer Tina Turner, who died this week at the age of 83 after a long illness, has written about her history of high blood pressure and kidney disease, leading to a kidney transplant.
Turner should be applauded for her willingness to share her medical history to publicise the importance of looking after your kidneys, just months before she died.
Turner's family has not confirmed how she died. But Turner's openness with her long-standing illness is a reminder for us all to keep an eye on our blood pressure, and to control it, if we are to avoid complications.
Here's why controlling your blood pressure is so important and what can happen if we don't.
Why is high blood pressure linked to kidney disease?There's a bi-directional relationship between blood pressure and kidney disease.
That means high blood pressure increases the risk for kidney disease and once you have kidney disease, it further promotes high blood pressure. It's a vicious cycle.
In some cases, it's hard to determine which one came first.
Uncontrolled blood pressure exerts a lot of pressure on the kidney. That leads to scarring and damage. If we looked inside the kidney, we'd see large areas of scarring. Once you have scarring, that tissue isn't working properly and can start to leak protein into the urine. That then pushes up the risk of progressive kidney disease, leading to kidney failure, heart disease and premature death.
The kidney itself is integral to maintaining blood pressure. Kidneys obviously maintain fluid balance by passing urine, but they also have important hormonal jobs which are vital to maintaining blood pressure.
So, once you get kidney disease, blood pressure can be really hard to manage. It's like a hammer and nail, and the nail is the kidney. If you have high blood pressure, the hammer is hitting the nail really, really hard.
Read more: Health Check: what do my blood pressure numbers mean?
Are there certain symptoms to look out for?Both high blood pressure and kidney disease are what we call "clinically silent", so many people don't realise they have problems until it is very far along.
Often a person with high blood pressure has no symptoms. There are times, in extreme cases, where people may get headaches or a feeling of thumping in the head. But their first sign may be a stroke or heart attack or some other major complication. That's why checking blood pressure on a regular basis is smart.
For kidney disease, you can lose up 90% of kidney function before symptoms develop. They can be clinically silent right up until kidney failure. When symptoms do arrive, they can be very vague – things like poor concentration or feeling tired.
Often people just put it down to winter, being busy or getting older.
So we recommend screening for kidney disease if you have high blood pressure, diabetes, heart disease, excess abdominal weight, a history of smoking, acute kidney injury or a family history of kidney disease. This should be done on a one- to two-year basis.
Tina Turner wrote about her history of high blood pressure and kidney disease, leading to a kidney transplant. AP Photo/Orlin WagnerRead more: Kidneys are amazing for all they do, be sure to look after yours
What are the treatments?In the past five years, there have been a swathe of newer medicines that bring down blood pressure and protect the kidney. For around 20 years, we have had a class of drugs called renin-angiotensin system blockade (usually just shortened to RAS blockade).
But more recently, we have a new group of medicines called SGLT2 inhibitors, which have really changed the landscape of kidney disease. The Therapeutic Goods Administration has just approved another medicine called finerenone, which is a non-steroidal MRA.
These have all been shown to protect the kidney, as opposed to just treating symptoms. They slow the progression of the disease and have shifted the paradigm to kidney preservation.
And it's really crucial you address the lifestyle factors that increase your risk.
Beyonce and Tina Turner performed at the Grammy Awards in 2008. AP Photo/Kevork DjansezianRead more: Explainer: what is chronic kidney disease and why are one in three at risk of this silent killer?
How can I reduce my risk?Don't smoke. Being a smoker significantly increases your risk of high blood pressure and kidney disease.
Eat a nutrient-dense diet, including fresh, whole foods that are in season and avoid ultra-processed food and sugar. This approach will help to control blood pressure and protect the kidney.
Do all the usual things – get good sleep, maintain an active lifestyle and manage your stress. If you have a family history of kidney disease, that may prompt you to get checked.
Do the Kidney Health Australia quiz and if you are deemed to be at risk, go to your GP to get a kidney health check. That involves a blood pressure check, urine test and a blood test.
Read more: Health Check: what can your doctor tell from your urine?
Kidney disease is becoming more commonThe number of people with kidney failure is increasing dramatically. According to the Australian Institute of Health and Welfare, the number of Australians receiving kidney replacement therapy (either on dialysis or living with a transplant) more than doubled between 2000 and 2020, from 11,700 to 27,700. Over half of those receiving kidney replacement therapy were on dialysis.
While a kidney transplant improves quality of life and can extend a person's life, it's important to remember that high blood pressure can still persist and often requires ongoing treatment.
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