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Long-term renal function in primary hypertension. An epidemiological and pathophysiological study
1Department of Nephrology and the Hypertension Clinic, Sahlgrenska University Hospital, Göteborg University, Sweden.
Insights
Preterm birth may increase adult hypertension risk. Good blood pressure control protects kidneys, but intensive treatment is needed to normalize renal blood flow and resistance in hypertensive individuals.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Epidemiology
Background:
- Birth factors may influence adult cardiovascular health.
- Long-term consequences of primary hypertension on renal function are not fully understood.
- The impact of intensified blood pressure management on renal hemodynamics requires further investigation.
Purpose of the Study:
- To investigate the influence of birth factors on adult blood pressure.
- To examine long-term renal function and hemodynamic changes in primary hypertension.
- To assess the effects of intensified blood pressure control on renal parameters and urinary albumin excretion.
Main Methods:
- Analysis of birth variables in relation to adult blood pressure in a cohort born in 1926-27.
- 14-year follow-up of renal function, hemodynamics, and urinary albumin excretion in normotensive and hypertensive men.
- Investigation of intensified blood pressure control (DBP ≤ 85 mmHg) using felodipine or ramipril in hypertensive patients.
- 20-year assessment of serum creatinine levels in hypertensive men from the Primary Prevention Study to evaluate end-stage renal disease risk.
Main Results:
- Preterm birth (gestational age < 38 weeks) was associated with an increased risk of adult hypertension.
- Good long-term blood pressure control (DBP ≤ 90 mmHg) preserved glomerular filtration rate and reduced proteinuria but did not normalize renal blood flow or vascular resistance.
- Intensified blood pressure control to DBP ≤ 85 mmHg with felodipine normalized renal blood flow and vascular resistance.
- Ramipril treatment lowered blood pressure and urinary albumin excretion but did not fully normalize renal hemodynamics.
- No hypertensive patients in the Primary Prevention Study developed end-stage renal disease within 20 years with good blood pressure control.
Conclusions:
- Preterm birth is a potential risk factor for adult hypertension.
- Effective blood pressure management is crucial for protecting kidney function in hypertensive individuals.
- Intensified antihypertensive therapy, particularly with felodipine, can restore normal renal hemodynamics in primary hypertension.
- Patients with non-malignant primary hypertension and good blood pressure control are unlikely to develop progressive kidney decline or end-stage renal disease.
Abstract:
The purpose of this study was to investigate the influence of birth factors on adult blood pressure and to study the long-term renal function and hemodynamic changes in primary hypertension. The investigations were performed in two population-based samples of men derived from two large screening investigations on blood pressure, a screening investigation of 49-year-old men and the Primary Prevention Study. Birth variables were studied in 430 subjects, born in 1926-27, who had participated in the screening investigation of 49-year-old men in Göteborg. The 14-year follow-up study of renal function and haemodynamics and urinary albumin excretion was performed in a stratified random sample of normotensive (n = 11) and hypertensive (n = 23) 49-year-old men. The effects of intensified blood pressure control (to a diastolic blood pressure, DBP < or = 85 mmHg) on renal function, haemodynamics and urinary albumin excretion, achieved by addition of felodipine or ramipril to ongoing treatment with beta-blockade, were investigated in 28 hypertensives. To determine if treated primary hypertension can lead to end-stage renal disease, the development of serum creatinine levels during 20 years in 686 hypertensive men from the Primary Prevention Study, recruited from a random third of the male population aged 47-55 years at entry, was studied. The findings demonstrate that preterm birth (gestational age less than 38 weeks) seemed to increase the risk of hypertension in adult life. They also showed, that good long-term blood pressure control (DBP < or = 90 mmHg) in primary hypertension can protect the kidneys from abnormal progressive decline in glomerular filtration rate and arrest proteinuria but does not normalise the reduced renal blood flow or the increased renal vascular resistance seen in primary hypertension. On decreasing the DBP to < or = 85 mmHg, achieved by addition of felodipine to ongoing treatment with beta-blockade, renal blood flow increased and renal vascular resistance decreased to levels no longer significantly different from normal. Addition of ramipril to beta-blockade reduced blood pressure less and renal function and haemodynamics did not normalise, but the urinary albumin excretion was lowered. The median value for the urinary albumin excretion remained within the range of the urinary albumin excretion of the normotensives in both the felodipine and the ramipril-treated groups. In the Primary Prevention Study, none of the hypertensives developed a hypertensive end-stage renal disease and only a few patients showed a slight increase in serum creatinine level before the age of 70. Thus, white patients with non-malignant primary hypertension without underlying renal disease and with good blood pressure control do not appear to develop progressive decline in kidney function or hypertensive end-stage renal disease.