[Hypertension in patients with chronic renal disease]

Hypertension belongs to the clinical picture of chronic renal disease (CRD). Its frequency depends on the type of nephropathy and the stage of CRD. Whatever the primary renal disease, more than 80% of patients beginning dialysis do have hypertension. The pathophysiology of hypertension in those patients involves a hyperactivity of renin-angiotensin system, as well as a decrease of sodium excretion capacity accompanying the decrease in glomerular filtration rate. Hypertension is the leading factor of renal disease progression as suggested by the relationship between blood pressure and function decay, and demonstrated by the results of antihypertensive intervention studies. The interaction between blood pressure and proteinuria is extremely detrimental. Hypertension is an important factor of cardiovascular risk excess observed in CRD patients, but the effect of antihypertensive treatment on cardiovascular risk remains limited in those patients, due to accumulation of other major risk factors. Finally, it is worth noting to mention the increasing place of vascular nephropathy, especially due to essential hypertension, amongst the causes of end-stage renal disease, where it compare with diabetic nephropathy accounting for 20% of incident patients in France.