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APOL1 genotype, blood pressure, and survival in African Americans with nondiabetic nephropathy

Todd W Robinson1, Barry I Freedman1

  • 1Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.

Kidney International
|January 15, 2017
PubMed

Insights

Aggressive blood pressure control has shown disappointing results in slowing chronic kidney disease progression. Future research focuses on long-term survival and gene-environment interactions, like apolipoprotein L1, in kidney disease management.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Genetics

Background:

  • Aggressive hypertension control trials for chronic kidney disease (CKD) have yielded limited success.
  • Lowering blood pressure, even with renin-angiotensin system blockade, does not consistently prevent end-stage kidney disease.

Purpose of the Study:

  • To review current findings on hypertension control and CKD progression.
  • To discuss the impact of hypertension management on CKD survival.
  • To explore apolipoprotein L1 gene interactions with blood pressure in CKD.

Main Methods:

  • Review of landmark clinical trials on hypertension control in nondiabetic CKD.
  • Analysis of data on long-term effects of blood pressure management on CKD survival.
  • Examination of genetic factors, specifically apolipoprotein L1, in relation to blood pressure and CKD.

Main Results:

  • Aggressive hypertension control has generally failed to halt the progression of nondiabetic CKD.
  • Current evidence suggests limited benefits of intensive blood pressure lowering on preventing end-stage kidney disease.
  • Longer-term survival data in CKD patients with hypertension is an emerging area of study.

Conclusions:

  • Intensive blood pressure management alone is insufficient for preventing end-stage kidney disease in CKD patients.
  • Further investigation into gene-environment interactions, such as apolipoprotein L1 and blood pressure, is crucial for understanding CKD progression.
  • A comprehensive approach considering genetic factors may be necessary for optimizing CKD management and patient survival.

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