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Long-term improvement in renal function after short-term strict blood pressure control in hypertensive
W A Pettinger1, H C Lee, J Reisch
1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
Insights
Strict blood pressure control in hypertensive nephrosclerosis patients unexpectedly improved renal function. This suggests kidney damage from hypertension may not always be irreversible, offering new hope for treatment.
Area of Science:
- Nephrology
- Cardiology
- Clinical Research
Background:
- Hypertensive nephrosclerosis is a common cause of chronic kidney disease.
- The progression of renal dysfunction in these patients is often considered irreversible.
- Previous studies suggested a continuous decline in renal function.
Purpose of the Study:
- To determine the pattern of renal function decline in hypertensive nephrosclerosis.
- To compare strict (≤80 mm Hg) versus conventional (90-95 mm Hg) diastolic blood pressure control for preserving renal function.
- To investigate the impact of blood pressure management on kidney function in this population.
Main Methods:
- Prospective, randomized, single-blind study.
- Inclusion criteria: serum creatinine 1.6-7.0 mg/dl, GFR <70 ml/min/1.73 m2, no other renal disease.
- Renal function assessed by GFR ([125I]iothalamate clearance) and serum creatinine.
Main Results:
- Unexpected significant improvement in renal function observed in both strict and conventional DBP control groups.
- Twenty-two subjects enrolled for 36 months (14 strict, 8 conventional).
- Contrary to expectations, renal function improved, not declined, in all patients.
Conclusions:
- Irreversible progression of renal damage in hypertensive nephrosclerosis may not be inevitable.
- Aggressive and conventional blood pressure management can lead to long-term improvement in renal function.
- The study's interventions, not just disease course, positively impacted renal function.
Abstract:
Seventy-nine hypertensive nephrosclerosis patients entered a prospective randomized single-blind study to 1) establish the pattern of decay of renal function in this population and the variability therein and 2) to determine if strict diastolic blood pressure (DBP) control (less than or equal to 80 mm Hg) is more effective than conventional levels (90-95 mm Hg) in conserving renal function. Because of unexpected significant improvement in renal function in patients from both groups, which changed the perspectives on the course of this disease as described herein, this report is being published before completion of the trial. The selection criteria were 1) serum creatinine concentration of 1.6-7.0 mg/dl, 2) glomerular filtration rate of less than 70 ml/min/1.73 m2, and 3) absence of diseases (other than hypertension) known to destroy renal function. Renal function was assessed by glomerular filtration rate [( 125I]iothalamate clearance) and serum creatinine concentration. Before randomization, DBP was aggressively treated to reduce it to less than 80 mm Hg. Twenty-two subjects (14 in the strict DBP control group and eight in the conventional DBP control group) have been enrolled in the study for 36 months. In contrast to results from previous studies in humans and rats, renal function improved in both patient groups. Thus, irrevocable progression of renal damage after onset of renal failure from high blood pressure does not necessarily occur, and in fact, long-term improvement of renal function resulted from the effects of the study itself.(ABSTRACT TRUNCATED AT 250 WORDS)