Does non-malignant essential hypertension cause renal damage? A clinician's view

Clinical research amongst hypertensive patients, randomised controlled trials, and population studies confined to white communities all show scant evidence that 'essential' non-malignant non-proteinuric normo-creatininaemic hypertension leads to renal impairment. Retrospective data from dialysis and transplantation units also tend to confirm this point. The only convincing exception is in studies of African Americans where there does appear to be a relationship between blood pressure (BP) at screening and the subsequent development of renal impairment. However, it is not possible to be certain that those patients who develop renal impairment might not have had a low grade sub clinical glomerulonephritis when first seen. One must conclude, therefore, that if benign essential hypertension does damage the kidneys, it does so very rarely. In that respect the epidemiology of hypertension-induced renal damage is different from that of coronary heart disease and stroke. Additional and novel risk factors need to be sought.