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Kidney damage in 'benign' essential hypertension
P K Whelton1, J He, T V Perneger
1Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA. pwhelton@mailhost.tcs.tulane.edu
Insights
High blood pressure significantly predicts kidney damage and worsening renal disease. Systolic blood pressure elevation is a key risk factor, even within the normal range, emphasizing the need for blood pressure management in kidney patients.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Observational studies increasingly highlight hypertension as a critical independent predictor of renal damage.
- Elevated blood pressure is linked to the progression of existing kidney disease, and increased morbidity and mortality in renal failure patients.
Purpose of the Study:
- To review emerging evidence on the relationship between blood pressure and renal disease.
- To discuss the role of systolic versus diastolic blood pressure in predicting renal risk.
- To highlight the impact of angiotensin-converting enzyme inhibitors in renal insufficiency.
Main Methods:
- Analysis of recent observational studies on blood pressure and renal outcomes.
- Review of clinical trial data regarding antihypertensive treatments in renal insufficiency.
- Examination of newly published clinical guidelines for hypertension management in renal disease.
Main Results:
- High blood pressure is an independent predictor of incident renal damage and progression of existing renal disease.
- Systolic blood pressure elevation appears to be a stronger risk predictor than diastolic pressure.
- A continuous, positive relationship exists between blood pressure and renal disease across the entire spectrum, including normotensive ranges.
Conclusions:
- Blood pressure management is crucial for preventing and managing renal disease.
- Angiotensin-converting enzyme inhibitors show benefits in patients with renal insufficiency.
- Ongoing trials and new guidelines offer valuable direction for clinical practice in managing hypertension in patients with kidney disease.
Abstract:
During the past 12 months additional evidence has emerged from observational studies indicating that high blood pressure is an important independent predictor of incident renal damage, progression of existing renal disease, and morbidity and mortality in patients with renal failure. Several of these studies suggest that elevation of systolic blood pressure is a stronger predictor of risk than a corresponding increase in diastolic blood pressure. Furthermore, the relationship between blood pressure and incident renal disease appears to be positive and continuous throughout the entire spectrum of blood pressure, including in the 'normotensive' range. Recent clinical trial experience in patients with renal insufficiency of diverse etiology supports the beneficial effect of treatment with angiotensin-converting enzyme inhibitors noted in earlier studies confined to patients with type II diabetes. Ongoing trials should help clarify optimal choice of antihypertensive medications and goals for reduction of blood pressure in prevention of renal disease. In the interim, two new guidelines for management of hypertension in patients with existing renal disease provide helpful guidance for the clinician.