• This damage often happens with no warning signs — Most people don’t realize their kidneys are under strain until the disease is already advanced. Early on, you won’t feel pain. You won’t see clear symptoms. But inside your body, the pressure is suffocating your kidneys' filtering system. By the time symptoms like swelling (edema), fatigue, or changes in urination show up, the damage is often severe.

• This is a major public health crisis hiding in plain sight — Nearly 108 million adults in the U.S. — almost half — have high blood pressure. Of those, roughly 1 in 5 already has some level of kidney disease. That’s over 20 million Americans walking around with a damaged filtration system and no idea it’s happening.

• High blood pressure is the second leading cause of kidney failure in the U.S. — Only diabetes causes more kidney damage.³ Once kidneys fail, your only options are dialysis or a transplant. And even with treatment, quality of life drops sharply. The burden isn’t just physical — it’s financial and emotional, too. Keeping blood pressure in check is far easier than treating full-blown kidney failure.

• Specific populations face even higher risks — Black adults are hit hardest. While they make up just 13% of the U.S. population, they account for 35% of all kidney failure cases.⁴ Food access, chronic stress, underdiagnosis, and lack of preventive care all contribute to the disproportionate damage in Black communities.

• Regular testing is the only way to catch early kidney damage — NIDDK recommends checking your glomerular filtration rate (GFR) through a blood test and looking for albumin (a type of protein) in your urine. Healthy kidneys don’t let protein leak into your urine. If they do, that’s a red flag that damage has already started.

Your kidneys rely on healthy blood flow to filter waste and regulate fluid balance. When high blood pressure restricts this flow, kidneys struggle to perform one of their most important roles: clearing out toxins. That failure doesn’t just impact the kidneys — it backs up waste into the bloodstream, affects every organ system, and leads to systemic dysfunction.

• Older adults were the most affected group in this analysis — For people in their 60s and older, high blood pressure drastically increased the likelihood of developing CKD. Even among participants with similar incomes, ethnic backgrounds, diabetes status, or medication use, those with high blood pressure still had much higher odds of kidney damage. According to Appiah, “That is not just a clinical statistic — it is a wake-up call.”

• Routine care is missing the window for early kidney damage detection — Appiah called out a critical flaw in current medical practice: doctors often treat high blood pressure as a heart issue while ignoring the kidneys. Appiah stressed that this leads to delayed detection and missed intervention opportunities. He wrote, “If we are not actively looking for it — especially in patients with high blood pressure — we are missing a crucial window for prevention.”

• The lack of testing allows CKD to quietly progress toward organ failure — Kidney damage builds slowly, with no obvious warning signs in early stages. According to Appiah, once symptoms like fatigue, swelling, or changes in urination show up, it’s often too late to reverse the damage. He urged doctors to screen all older adults with high blood pressure using two simple tools:

These tests are inexpensive, noninvasive, and widely available, but underused in routine care for older adults with high blood pressure.

• Early intervention means better outcomes and lower costs — Treating CKD once it becomes advanced is expensive and life-altering. Appiah emphasized that integrating kidney screening into routine blood pressure management would prevent massive downstream suffering. “We cannot afford to ignore the silent progression of CKD in older adults,” he wrote. “Especially when one of its biggest risk factors, hypertension, is already in the exam room.”

• The call to action is clear: expand the narrative — Appiah challenged the health care system to rethink how it frames blood pressure. “Let us start by expanding the narrative around high blood pressure to include the kidneys,” he urged. “Let us normalize early kidney screenings for hypertensive patients.”

• Healthy aging doesn’t lead to kidney failure — The researchers emphasized that when older adults avoid diseases like high blood pressure and diabetes, their kidney function tends to stay relatively stable. This directly contradicts the widespread assumption that kidney decline is an inevitable part of aging. In fact, the study found that healthy elderly participants had lower, but still normal, filtration rates when measured by inulin clearance, a precise method for testing kidney function.

• The real risk comes when age meets disease — When high blood pressure is added to the picture, the decline in kidney function becomes more aggressive and clinically significant. The study noted that chronic high blood pressure doesn’t just raise numbers — it physically changes the structure of the kidney’s filtration system. Over time, the increased pressure stiffens and scars blood vessels, reducing your kidneys’ ability to clear waste efficiently.

• Preventive lifestyle habits make the biggest difference — The paper highlighted several lifestyle strategies that help preserve kidney health in older adults — even those with mild age-related decline.

These include exercise to support healthy blood flow and improve blood pressure control and careful monitoring of medication side effects to ensure the kidneys aren’t being harmed by drugs. These strategies help extend the period of functional kidney health, reduce medication dependency, and improve overall quality of life.

• Aging doesn’t guarantee disease but neglect does — This study challenges the belief that kidney failure is an automatic part of growing older. It’s not your age — it’s what your blood pressure is doing to your kidneys behind the scenes. And the sooner you catch that damage, the more control you have over the outcome.

1. Fix your sodium-to-potassium ratio by eating real food — The problem isn’t salt itself — it’s ultraprocessed food. Most people get their sodium from boxed snacks, canned goods, deli meat, and fast food, which are stripped of potassium.

Your body needs potassium to relax blood vessels and lower pressure. If you're eating mostly whole, unprocessed foods — like ripe fruit, root vegetables, and well-cooked leafy greens — you’ll naturally get more potassium and less sodium, the way your kidneys were designed to handle.

2. Skip the low-salt diet and focus on nutrient density — Cutting salt too aggressively backfires. It increases insulin levels, worsens your cholesterol ratios, and puts your body into a stress state that makes high blood pressure harder to control. If you’ve been told to cut all salt, you’ve been misled.

Instead, focus on eliminating ultraprocessed foods and use a small amount of high-quality mineral salt on meals made from scratch. That way, you’re not stressing your system or spiking insulin just to chase lower numbers.

3. Use simple breathing exercises to lower your stress response — High blood pressure isn’t just physical — it’s emotional. Chronic stress triggers hormones that tighten blood vessels and drive your pressure up. Try this: box breathing. Inhale for four seconds, hold for four, exhale for four, and hold again for four. Do this for 10 minutes a day. It’s free, easy, and trains your nervous system to stop overreacting. You’ll feel calmer, and your blood pressure will follow.

4. Get your vitamin D levels into the optimal range — Vitamin D helps regulate the renin-angiotensin system, a hormone network that directly controls blood pressure. If your vitamin D levels are too low, this system becomes overactive, driving up pressure and damaging your kidneys. Make sure you’re getting regular sun exposure, but avoid peak hours (10 a.m. to 4 p.m.) if you consume linoleic acid (LA) from vegetable oils.

LA is a polyunsaturated fat that oxidizes easily, builds up in your skin and increases your risk of skin damage. Cut these oils from your diet for at least six months before getting peak sun exposure. Get your vitamin D levels tested at least twice a year and aim for a level between 60 and 80 ng/mL (150 to 200 nmol/L). Consider a vitamin D3 supplement if you don’t get sun exposure regularly.

5. Move more — but start with what’s doable for you — If you're already active, aim for an hour of moderate aerobic movement daily, like walking, cycling, or swimming. But if you're starting from zero, don’t overthink it. Even 10-minute walks after meals are beneficial. The key is consistency. Your kidneys will thank you for every step.