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The Kidney in Hypertension

Hillel Sternlicht1, George L Bakris1

  • 1Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, ASH Comprehensive Hypertension Center, The University of Chicago Medicine, 5841 South Maryland Avenue, MC 1027, Chicago, IL 60637, USA.

The Medical Clinics of North America
|November 26, 2016
PubMed

Insights

Hypertension and chronic kidney disease (CKD) are closely linked. Recent advances in blood pressure, glycemic, and cholesterol control have significantly slowed CKD progression and reduced albuminuria over 3 decades.

Area of Science:

  • Nephrology
  • Cardiology
  • Internal Medicine

Background:

  • Hypertension is a leading cause of chronic kidney disease (CKD) and accelerates kidney failure.
  • CKD can also lead to resistant hypertension, creating a complex clinical challenge.
  • Nephropathy progression has historically been rapid, contributing to significant morbidity.

Purpose of the Study:

  • To analyze trends in nephropathy progression over the past three decades.
  • To evaluate the impact of improved management strategies on CKD and related complications.
  • To understand the relationship between hypertension, CKD, and albuminuria levels.

Main Methods:

  • Retrospective analysis of patient data over a 30-year period.
  • Examination of trends in kidney function decline (mL/min per year).
  • Assessment of changes in albuminuria incidence and progression rates.

Main Results:

  • Nephropathy progression has slowed significantly, from 8 mL/min/year to 2-3 mL/min/year.
  • The incidence of very high albuminuria and progression from high to very high levels has decreased.
  • Improvements correlate with better blood pressure, glycemic, and cholesterol management.

Conclusions:

  • Enhanced control of hypertension, diabetes, and hyperlipidemia has markedly improved CKD outcomes.
  • These advancements have substantially reduced the rate of kidney function decline and albuminuria.
  • Current therapeutic strategies are effective in slowing the progression of hypertensive nephropathy.

Keywords:
DiabetesHypertensionKidneyOutcomesRenal

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