The kidney as a target of hypertension

In spite of improvement in blood pressure control during the last decades, the incidence of hypertension-related end-stage renal disease (ESRD) is reported to have increased and has become a common cause of renal failure, especially in the United States, but also in several other countries. The clinical diagnosis of hypertensive nephrosclerosis is usually presumptive, and an important differential diagnosis in older hypertensive persons is atheromatous renal vascular disease. Many studies of renal function in treated essential hypertension have shown a small and clinically insignificant decline in glomerular filtration rate (GFR). Recent long-term studies indicate that the change in GFR may be nonlinear, with a greater fall in GFR after initiation of antihypertensive treatment, followed by a phase of minimal or normal loss of GFR. There are no available prospective studies indicating that well-treated essential hypertension leads to renal failure, but there are new data indicating that patients with nonmalignant essential hypertension without any underlying renal disease and with early and good blood pressure control do not develop renal failure.