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Blood pressure control in essential hypertension and impairment of renal function with age
U F Mondorf1, K Frey, A Radounikli
1Department of Medicine, Division of Nephrology, Johann Wolfgang Goethe-Universität, Frankfurt am Main, Germany. mondorf@em.uni-frankfurt.de
Insights
Effective blood pressure control is crucial for preserving kidney function in patients with essential hypertension. Poorly controlled hypertension accelerates age-related decline in renal function and increases the risk of impaired creatinine clearance and proteinuria.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Hypertension is a leading cause of end-stage renal disease (ESRD).
- Assessing blood pressure control's impact on renal function is vital for patient management.
- Essential hypertension requires careful monitoring to prevent kidney damage.
Purpose of the Study:
- To evaluate the relationship between blood pressure control levels and renal function in patients with essential hypertension.
- To determine how age influences renal function (creatinine clearance) across different blood pressure control strata.
- To investigate the prevalence of impaired renal function and proteinuria in relation to hypertension severity.
Main Methods:
- A cohort of 103 patients with essential hypertension was analyzed.
- Patients were categorized into three groups based on blood pressure control: normalized (<140/90 mmHg), mild (140-159/90-99 mmHg), and moderate-to-severe (>160/100 mmHg).
- Creatinine clearance (Ccr), age, and proteinuria were assessed and correlated within each group.
Main Results:
- A significant negative correlation between age and Ccr was observed in patients with normalized and mild hypertension.
- The rate of Ccr decline with age was steeper in the mild hypertension group compared to the normalized group.
- Moderate-to-severe hypertension showed no correlation between age and Ccr, suggesting other factors dominate. Impaired Ccr was more prevalent in groups with higher blood pressure, as was proteinuria.
Conclusions:
- Maintaining normalized blood pressure is essential for preserving renal function and mitigating age-related decline in Ccr.
- Suboptimal blood pressure control in essential hypertension significantly increases the risk of impaired renal function and proteinuria.
- Aggressive blood pressure management is critical in preventing hypertension-induced kidney disease.
Abstract:
Hypertension has been recognized to be an important cause for the development of end-stage renal disease (ESRD). We assessed the quality of blood pressure control in 103 patients with essential hypertension and correlated renal function and age. Patients were stratified into three subgroups by their blood pressure level under current medication. Group 1 were hypertensive patients with normalized blood pressure (<140/90 mmHg, n = 25), group 2 patients with mild hypertension (140-159/90-99 mmHg, n = 43) and group 3 patients with moderate to severe hypertension (> 160/100 mmHg, n = 35). A negative correlation between age and creatinine clearance (Ccr) could be confirmed for patients of group 1 (correlation coefficient r1 = -0.56; p, < 0.01) and group 2 (r2 = -0.55; P2 < 0.001). Furthermore the regression coefficient (m) of decline in C(Cr) versus age was higher in group 2 patients (m2 = -1.83) than in group 1 (m1 = -1.30). In group 3 we found no correlation of renal function with age, indicating that age may not be the leading variable. Patients in group 1 were all within normal limits of age adjusted Ccr, but 12% in group 2 and 23% in group 3 had impaired C(Cr). Furthermore proteinuria was found to be 20% (group 1), 26% (group 2) and 31% (group 3). This analysis provides further evidence of the importance of blood pressure control in essential hypertension to preserve renal function.