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[Hypertension and renal insufficiency]
1Service de néphrologie et hypertension artérielle, pavillon P, hôpital Edouard-Herriot, 69437 Lyon.
Insights
Controlling high blood pressure is crucial for patients with chronic kidney disease. Normalizing blood pressure, especially with angiotensin converting enzyme inhibitors, slows kidney function decline and prevents terminal renal failure.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Context:
- Hypertension is a common complication and cause of chronic renal failure, accelerating disease progression.
- Vascular and ischemic renal parenchyma damage are consequences of uncontrolled hypertension leading to end-stage renal disease.
- 10-25% of new dialysis patients are classified as hypertensive, highlighting the prevalence of vascular renal disease.
Purpose:
- To quantify the influences of hypertension, proteinuria, and metabolic factors on renal function decline.
- To evaluate the benefits of blood pressure normalization in diabetic and non-diabetic kidney disease.
- To assess the role of angiotensin converting enzyme inhibitors in managing hypertensive nephropathy.
Summary:
- Recent cohort studies and clinical trials demonstrate that normalizing blood pressure significantly benefits patients with renal disease, particularly when proteinuria is pronounced.
- Treatment including angiotensin converting enzyme inhibitors is especially effective in slowing the degradation of renal function.
- Elevated blood pressure, both systolic and diastolic, increases the risk of renal failure, with diastolic increases of 20 mmHg doubling creatinine increase risk.
Impact:
- Highlights the critical role of blood pressure management in preventing progression to end-stage renal disease.
- Emphasizes the importance of early and effective antihypertensive treatment, including ACE inhibitors, for kidney protection.
- Provides evidence for targeted interventions in high-risk populations to mitigate renal risk associated with hypertension.
Abstract:
Hypertension is almost an inevitable complication of chronic renal failure and it contributes to the acceleration of its progression to terminal renal failure. Cohort studies and large scale clinical trials carried out in the last 10 years have allowed quantification of the respective influences and interactions of hypertension, proteinuria, and metabolic factors on the rate of degradation of renal function. They have conclusively showed a benefit in normalising the blood pressure in diabetic and nondiabetic renal disease especially when the proteinuria is pronounced and when the treatment includes an angiotensin converting enzyme inhibitor. Hypertension is also an increasingly common cause of renal failure, which may become terminal by its consequences associating vascular and ischaemic lesions of the renal parenchyma. Depending on the country studied, 10 to 25% of new dialysis patients are now classified as hypertensive and vascular renal disease. The individual renal risk of essential hypertension is relatively low except in certain groups, such as the coloured population, especially in the USA. The risk of a significant increase in creatinine is doubled by any increase of 20 mmHg of diastolic blood pressure but long-term studies suggest that the effects of increased systolic blood pressure may be even greater.