Hypertension with co-existing renal disease

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Pharmacology

Background:

• Systemic hypertension treatment aims to prevent kidney injury, yet renal function can decline during therapy.
• Hypertensive nephrosclerosis causes 26% of end-stage renal disease (ESRD) in the US, with no evidence of incidence reduction despite aggressive treatment.
• Renal protection may depend on controlling both systemic and glomerular hypertension.

Purpose of the Study:

• To explore the hypothesis that interrupting angiotensin II activity (via ACE inhibitors) or its effects (via calcium antagonists) may protect the kidneys.
• To highlight the need for long-term clinical trials comparing renal effects of different antihypertensive drug classes.

Main Methods:

• Review of current understanding of hypertension's impact on renal function.
• Analysis of the proposed mechanisms of action for ACE inhibitors and calcium antagonists on intrarenal angiotensin II.
• Identification of the gap in long-term clinical trial data.

Main Results:

• ACE inhibitors effectively control both systemic and glomerular hypertension.
• Calcium antagonists control systemic hypertension and may influence glomerular hypertension.
• No reported long-term clinical trials directly compare the renal protective effects of ACE inhibitors versus other classes like calcium antagonists.

Conclusions:

• The precise renal protective advantages of different antihypertensive drug classes on the renal microcirculation remain undetermined.
• Further research is needed to ascertain if observed microcirculatory effects translate into tangible renal protection for at-risk patients.