The kidney as a victim of essential hypertension

Over the past decade the prevalence of end stage renal disease has risen progressively in industrialized societies. According to the data of renal disease Registries hypertensive nephrosclerosis appears to be a very important cause of progressive renal disease. However epidemiological data on the risk of hypertensive patients to develop renal failure offer contrasting results. In observational longitudinal studies a higher rate of decline in renal function is generally found in hypertensive compared to normotensive subjects. On the other hand, the inability of antihypertensive therapy to influence kidney destiny emerges from the large majority of interventional studies on mild-moderate hypertension in caucasian patients. At variance, the role of hypertension as etiologic factor seems to be sufficiently clear in African Americ: hypertension is more common, more severe and less easily to handle in a black patients. It is probable that the diagnosis of hypertensive nephrosclerosis is a confounding label laidon a heterogeneous group of diseases comprising a true hypertensive nephropathy (typical of black patients) along with occlusive or atheroembolic diseases common in aged caucasian patients. Our future efforts will have to be directed towards better identifying and properly classifying the various subgroup in order to optimize the treatment and prevent renal failure.