The kidney and antihypertensive therapy

Renal disease and hypertension is a continuing challenge to the nephrologist. At present there are few effective methods of dealing with the common renal diseases such as glomerulonephritis, but fortunately there is now a wide selection of potent antihypertensive agents. Drug resistant hypertension should be a rarity in clinical practice. Malignant hypertension remains a therapeutic emergency. If a patient with hypertension has renal functional impairment it is essential to lower the blood pressure to normal. In the presence of renal failure this should be done with caution so as to avoid a further deterioration in the glomerular filtration rate. However, if the blood pressure is controlled and especially if the renal failure is a result of hypertension alone, renal function may stabilise or even improve, often dramatically.