Hannah Zulueta The Loud Ones and the Quiet Ones
What a blood pressure cuff knows that a dog cannot say
A patient came into my clinic loud. Agitated in the waiting room, complaining before he even sat down. If you do not work in health care, you clock that and brace for a difficult morning. I took his vitals anyway. His blood pressure was almost high enough to send him straight to the ER. He was, just barely, someone I could still treat myself. The loudness was not his personality showing up wrong. It was his body, under real pressure, trying to say something before the numbers confirmed it.
A dog cannot be loud in a waiting room
A person carrying that kind of pressure will tell you, one way or another. He raises his voice. He complains about the wait. A dog with the same numbers will not. She lies in the exam room the way she always has, tail moving, eyes soft, and the only thing standing between you and the truth is a cuff around a leg and someone willing to check it. High blood pressure in a dog with kidney disease waits to be found.
Two directions at once
A dog does not develop kidney disease and then, separately, develop high blood pressure. The two conditions feed each other. Damaged kidneys lose some of their ability to manage sodium. They also lose control over the renin-angiotensin-aldosterone system, the hormonal loop that raises or lowers pressure based on the blood volume the kidney senses. Less working kidney tissue means less control over that loop, and pressure climbs.
Once pressure is elevated, it works against the kidney directly. Inside each remaining nephron, the filtering pressure in the glomerulus rises along with the pressure everywhere else in the body. That extra force speeds up the scarring, called glomerulosclerosis, already underway in a kidney losing function.
This is why blood pressure gets checked at every stage of kidney disease monitoring, not only once a dog looks sick.
The reading that lies
My patient’s agitation matched his numbers. That will not always be true of a dog. A strange room, an unfamiliar person’s hands, the smell of other animals nearby: any of it can push a dog’s blood pressure up temporarily, even when her true resting pressure is normal. Researchers call this the white coat effect, and it is not reserved for people. A study of retired racing greyhounds found blood pressure measured in the hospital ran significantly higher than the same dogs’ readings taken at home. The room mattered more than who was holding the cuff: a stranger and the dog’s own owner got the same reading there.
Because of this, a single high reading at a single visit is not enough to call a dog hypertensive. The consensus guidelines lay out a specific protocol before any number counts.
What pressure does when nobody’s looking
Untreated high blood pressure does its damage quietly, in four places at once. This is what veterinarians call target organ damage, and it is the reason blood pressure gets treated even in a dog who seems otherwise fine.
Bleeding, or detachment
Sustained pressure can cause bleeding inside the eye or detachment of the retina. In one study of dogs with acute kidney injury, sixteen percent already had visible hypertensive changes in the eye by the time they were examined. Sudden blindness in a dog with kidney disease is treated as a blood pressure emergency until proven otherwise.
A new murmur, a thickened wall
The heart has to work against higher resistance with every beat. Over time this can thicken the wall of the left ventricle and produce a murmur that was not there before.
Dullness, disorientation, seizure
Dullness, disorientation, or a seizure in a dog with known kidney disease can be a sign that pressure has reached the brain, not only a sign that the kidney disease itself is progressing.
The cause becomes the target
The kidney is both the cause and the target. Elevated pressure inside the glomerulus speeds the loss of the nephrons still working, closing the loop that started the whole problem.
Systolic blood pressure in mmHg, by risk of target organ damage.
Water that no longer holds Wood down
TCM has its own explanation for a pattern that looks a great deal like this one. Kidney Yin, the cooling, substantive fluid that nourishes and anchors the body, is meant to hold Liver Yang, the Liver’s active, rising force, in check. The classical relationship is Water nourishing Wood. When Kidney Yin runs low, whether from age or from a body already worn down by chronic disease, Water can no longer hold Yang down, and it rises unchecked toward the head.
In people, this pattern shows up as restlessness, a quick temper, headache at the temples, and a flushed face, the same signs behind that loud waiting room. I have learned, working with dog owners for as long as I have, to notice this pattern in the room even when nobody says a word about it. A dog often mirrors the person sitting across from her. Sometimes the owner tells me they carry the same condition themselves. More often I just recognize it, in the energy in the room, before anyone says so.
None of that diagnoses a dog. But it does inform how I think about diet once blood pressure is already part of the picture. A kidney disease diet built entirely around warming or pungent elements works against the goal of protecting what Yin remains. One built to gently support Yin quietly moves toward the same goal the medication is working toward from the pharmaceutical side.
The medication with two jobs
One of my longtime case dogs makes this whole picture concrete. She is an older, small mixed breed managed for kidney disease with a chronic protein-losing component, the kind where the kidney’s filter lets protein leak into the urine that should stay in the blood. For a long stretch, her blood pressure was managed with two drugs working from different angles: amlodipine, a calcium channel blocker that relaxes blood vessels directly, and an ARB, a class of drug that also happens to reduce the amount of protein spilling through a damaged glomerulus.
When her potassium climbed into a range that needed attention, the ARB was the drug that had to go. It had been doing two jobs. Amlodipine stayed and kept covering blood pressure on its own, but the second job, the protein protection, needed a new plan without it.
Sometimes the best drug for one problem is also the best drug for another, and losing it for a good reason still leaves a gap somewhere else. That is why blood pressure in a kidney disease dog gets managed alongside potassium, protein loss, and everything else the kidney touches, by a team watching the whole board and not just the one number in front of them.
Questions I hear
How would I know if my dog has high blood pressure?
In most dogs, there is nothing to see until there is damage. Sudden vision loss, a new heart murmur, or unexplained dullness can be the first outward sign. The only reliable way to know earlier is a blood pressure check as a routine part of kidney disease monitoring, not something you wait to ask for.
My dog seemed anxious at the vet. Does that reading count?
Not on its own. Stress alone can push a dog’s reading high enough to look hypertensive even when her true resting pressure is normal. That is why guidelines call for a calm room, time to settle, and more than one reading before anyone decides anything from a single number.
If my dog’s ARB gets stopped for a potassium problem, does her blood pressure go untreated?
No, but the team usually leans harder on another drug, most often a calcium channel blocker like amlodipine, and has to build a separate plan for whatever else that ARB was quietly handling, often reduced protein loss.
Can diet bring a dog’s blood pressure down on its own?
Diet supports the picture, particularly around sodium and overall kidney function, but it is not a substitute for measured, treated hypertension once a dog already shows elevated numbers or damage to an organ.
Some things you have to go looking for
My patient could tell me himself, loudly, without meaning to. Your dog cannot. The only way to know what her numbers are doing is to ask, and to keep asking, once kidney disease is already part of her story.
Acierno, M. J., Brown, S., Coleman, A. E., Jepson, R. E., Papich, M., Stepien, R. L., & Syme, H. M. (2018). ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats. Journal of Veterinary Internal Medicine, 32(6), 1803–1822. https://doi.org/10.1111/jvim.15331
Cole, L. P., Jepson, R., Dawson, C., & Humm, K. (2020). Hypertension, retinopathy, and acute kidney injury in dogs: A prospective study. Journal of Veterinary Internal Medicine, 34(5), 1940–1947. https://doi.org/10.1111/jvim.15839
Huang, X., Ngaenklangdon, S., He, J., & Gao, X. (2021). Traditional Chinese Medicine’s liver yang ascendant hyperactivity pattern of essential hypertension and its treatment approaches: A narrative review. Complementary Therapies in Clinical Practice, 43, 101354.
IRIS Kidney. (n.d.). Hypertension. International Renal Interest Society. https://www.iris-kidney.com/hypertension
Marino, C. L., Cober, R. E., Iazbik, M. C., & Couto, C. G. (2011). White-coat effect on systemic blood pressure in retired racing greyhounds. Journal of Veterinary Internal Medicine, 25(4), 861–865. https://doi.org/10.1111/j.1939-1676.2011.00735.x
Syme, H. (2011). Hypertension in small animal kidney disease. Veterinary Clinics of North America: Small Animal Practice, 41(1), 63–89. https://doi.org/10.1016/j.cvsm.2010.11.002
Hannah Zulueta obtained her Certificate in Canine Nutrition from CASI Institute. She is also studying for her Doctorate in Acupuncture, Traditional Chinese Medicine, and Herbalism from the esteemed Pacific College of Health and Medicine. If you’re as keenly interested in health for yourself, visit her website for human health: Satori Acupuncture and Herbs.
She resides in San Diego with her three dogs, Maggie, Orbit, and Mr. Higgins.
She is available for one on one consultations. She develops evidence-based recipes that meet both NRC and AAFCO nutritional standards while integrating the therapeutic food principles of Traditional Chinese Veterinary Medicine into her formulations.
Additionally, you can find her sharing free content on Instagram.
