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Hypertension and the kidney: determinants of the response to antihypertensive therapy and their implications

N K Hollenberg1

  • 1Department of Medicine, Harvard Medical School, Boston, MA.

American Heart Journal
|February 1, 1993
PubMed

Insights

Hypertension significantly impacts kidney health, potentially causing injury and end-stage renal disease. Certain therapies like angiotensin-converting enzyme inhibition may protect kidneys when other treatments fail.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • The intricate relationship between hypertension and kidney disease is well-established in medical literature.
  • The kidney can be both a cause (culprit) and a consequence (victim) of hypertension.
  • Hypertension is a leading cause of end-stage renal disease (ESRD), accounting for a significant percentage of dialysis and transplant cases.

Purpose of the Study:

  • To explore the dual role of the kidney in hypertension pathogenesis and its response to antihypertensive therapy.
  • To evaluate the effectiveness of different antihypertensive strategies in preventing or slowing renal injury.
  • To investigate the potential of specific drug classes, such as angiotensin-converting enzyme inhibitors and calcium channel blockers, in preserving renal function.

Main Methods:

  • Review of existing medical literature and clinical evidence.
  • Analysis of patient data regarding hypertension, renal injury, and treatment outcomes.
  • Comparative assessment of various antihypertensive therapies, including their impact on renal function.

Main Results:

  • Antihypertensive therapy can prevent or halt renal complications in accelerated hypertension.
  • Treatment is less effective in preventing progression to ESRD in moderate hypertension.
  • Angiotensin-converting enzyme inhibition and calcium channel blockade show promise in preventing progression to ESRD when other therapies are insufficient.

Conclusions:

  • The pathogenesis of hypertension influences the renal response to specific antihypertensive agents.
  • Selection of antihypertensive medication should consider the underlying pathogenetic features of hypertension for optimal renal protection.
  • Emerging guidelines aim to refine the selection of antihypertensive agents based on these factors.

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