[Treatment of renal hypertension]

In recent years in conjunction with medicamentous treatment of renoparenchymatous hypertension in particular two problems were discussed: target blood pressure values and renoprotective effects of antihypertensive drugs. Prospective studies revealed that a blood pressure reading of < 130/80 mm Hg significantly retards the progression of nephropathy whereby patients with proteinuria > 1 g/d benefit from even lower BP readings. In diabetic nephropathy the drugs of choice are inhibitors of angiotensin converting enzyme (ACEI), already in the incipient stage and also in normotensive patients. The importance of ACEI in the treatment of non-diabetic nephropathies was confirmed recently by controlled prospective studies AIPRI and REIN. A maximal renoprotective effect of ACEI probably calls for larger doses than those needed for normalization of BP. Long-term investigations of the renoprotective effect of antagonists of angiotensin AT1 receptors and comparative studies with ACEI resp. are not available. Dihydropyridine blockers of calcium channels with a short-term action (nifedipine) may have a negative influence on the progression of diabetic nephropathy, the effect of dihydropyridines of the second generation is tested in prospective studies. Non-dihydropyridine calcium channel blockers have a renoprotective action in diabetic nephropathy. In cca two thirds of the patients combined treatment with ACEI and diuretics or with calcium channel blockers is necessary. As to other antihypertensive drugs, vasodilatating beta-blockers and perspectively antagonists of endothelin receptors are useful.