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The kidney in hypertension: treatment strategies
1Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts 02115.
Insights
Controlling hypertension in patients with renal disease is crucial. Angiotensin-converting enzyme inhibitors show promise in slowing kidney damage, while vasodilating beta-blockers may offer additional benefits.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Hypertension management in patients with renal disease requires a multi-faceted approach.
- Cardiovascular risk is significantly elevated in hypertensive patients with kidney disease.
- Progression of renal disease is a major concern in this patient population.
Purpose of the Study:
- To outline the primary goals of managing hypertension in patients with renal disease.
- To review the evidence for antihypertensive agents in slowing renal disease progression.
- To explore the potential benefits of novel pharmacologic agents.
Main Methods:
- Review of existing clinical evidence and animal model studies.
- Analysis of the efficacy of angiotensin-converting enzyme inhibitors.
- Evaluation of beta-adrenergic blocking agents and vasodilating agents.
Main Results:
- Hypertension control is paramount for slowing renal injury progression.
- Angiotensin-converting enzyme inhibitors demonstrate consistent efficacy in preventing progressive renal injury.
- Beta-adrenergic blockers are indicated for specific cardiovascular conditions; vasodilating variants show preliminary promise.
Conclusions:
- Effective hypertension management is key to preserving renal function.
- Angiotensin-converting enzyme inhibitors are valuable in managing hypertensive nephropathy.
- Further research into vasodilating beta-blockers is warranted for optimizing outcomes in hypertensive patients with renal disease.
Abstract:
As in any patient with hypertension, the first goal in the hypertensive patient with renal disease is to control the hypertension. The second goal is to reduce overall cardiovascular risk, which includes an increased likelihood of coronary events. The third goal is to minimize the likelihood that renal disease will progress, or minimize the rate of progression. There is substantial evidence to indicate that control of hypertension, however achieved, will slow the rate of progression of renal injury and destruction. Studies in animal models have indicated that angiotensin-converting enzyme inhibitors are more consistent in preventing progressive renal injury, and perhaps have a more sustained action than standard agents employed hitherto. In the patient with a clear indication for beta-adrenergic blockade, such as a prior coronary event or angina pectoris, a beta-adrenergic blocking agent should be employed. Preliminary, but intriguing, evidence is available to suggest that a beta-adrenergic blocking agent that incorporates a vasodilator action may enjoy special benefits in terms of achieving the three goals. In the case of renal injury, completion of the studies required to prove this point will improve our ability to deal with the problem of hypertension in the patient with renal disease.