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[Treatment of arterial hypertension with renal involvement]
1Service de Néphrologie et d'Hypertension artérielle, Centre Hospitalier, Vannes.
Insights
To prevent hypertensive renal disease, maintain blood pressure below 130/85 mmHg, especially with proteinuria. Angiotensin-converting enzyme inhibitors are recommended for non-diabetic and diabetic kidney disease, with careful monitoring in renal failure.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Abstract:
TREATMENT GUIDELINES: To prevent the development of hypertensive renal disease of progression of underlying renal disease, the blood pressure goal should be 130/85 mmHg or less if possible when proteinuria exceeds 1 g/24 h. ANTIHYPERTENSIVE DRUGS: Converting enzyme inhibitors are recommended in patients with non-diabetic renal disease and, as first-line therapy, in diabetics with microalbuminurea or patent diabetic nephropathy with or without hypertension. TREATMENT ONSET: Converting enzyme inhibitors should be started progressively with a lower final dosage in case of renal failure. Creatinemia and kaliemia must be monitored. Combination therapy with diuretics is generally used, but potassium-sparing diuretics are contraindicated due to the risk of hyperkaliemia. Reduced sodium intake is essential to obtain maximum effect.