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Does an adequate control of blood pressure protect the kidney in essential hypertension?
L M Ruilope1, J M Alcazar, E Hernandez
1Department of Nephrology, Octubre Hospital, Madrid, Spain.
Insights
Elevated uric acid levels in primary hypertension patients predict kidney damage, even with blood pressure control. Long-term treatment may not fully protect kidney function, highlighting uric acid as a key prognostic marker.
Area of Science:
- Nephrology
- Cardiology
- Internal Medicine
Background:
- Primary hypertension is a leading cause of chronic kidney disease.
- Standard stepped-care therapy aims to manage blood pressure but its long-term impact on kidney function requires further investigation.
- Proteinuria is a significant indicator of kidney damage in hypertensive patients.
Purpose of the Study:
- To investigate the long-term effects of standard stepped-care therapy on kidney function in primary hypertension patients.
- To identify predictors of overt proteinuria development during antihypertensive treatment.
- To assess the role of uric acid levels in the prognosis of primary hypertension.
Main Methods:
- Analysis of clinical data from 120 primary hypertension patients over a 9-year follow-up period.
- Standard stepped-care therapy including diuretics, beta-blockers, and vasodilators was administered.
- Comparison of baseline and follow-up parameters, including blood pressure, serum creatinine, glucose, lipids, and uric acid, between patients who developed proteinuria and those who did not.
Main Results:
- 21 patients (17.5%) developed overt proteinuria despite adequate blood pressure control.
- Initially higher uric acid levels and diastolic blood pressure were associated with subsequent proteinuria development (P < 0.01).
- Uric acid levels remained significantly elevated in proteinuric patients throughout the follow-up period.
Conclusions:
- Long-term antihypertensive treatment does not fully prevent kidney damage in all primary hypertension patients.
- Elevated baseline uric acid levels are a significant predictor of poor prognosis and kidney damage in primary hypertension.
- Monitoring and management of uric acid may be crucial for improving long-term outcomes in hypertensive individuals.
Abstract:
We analyzed the clinical course of 120 patients who were diagnosed as having primary hypertension and subsequently given standard stepped-care therapy (diuretic, beta-blocker and vasodilator) for 9 years. At the end of the follow-up period, 21 patients (17.5%) had developed overt proteinuria. The initial study showed no difference in systolic blood pressure, age, sex, serum creatinine and its clearance, glucose, cholesterol and triglycerides between these patients and those who had not become proteinuric, but uric acid levels and diastolic blood pressure were higher (both P less than 0.01). An adequate control of blood pressure was obtained and maintained in all patients, who had similar therapeutic needs. During the follow-up period, uric acid levels remained significantly elevated (P less than 0.01) in the proteinuric patients, while changes in serum glucose, cholesterol and triglycerides were similar in all patients. These results indicate that long-term treatment of primary hypertensives does not fully protect kidney function and that initially elevated uric acid levels could be a predictor of a poor prognosis.