[Hypertension and the kidney]

In the past 30 years, the paradigms to explain the relation between hypertension and progression of renal disease have changed in a dramatic fashion. Thirty years ago it was believed that high blood pressure was necessary to permit the damaged kidney to maintain its function. In contrast, today solid evidence is available that blood pressure is the most important factor accelerating progressive loss of renal function. Furthermore, on the basis of recent observations, target blood pressure during antihypertensive therapy has been substantially lowered. Finally, it could be documented that for interfering with progressive loss of renal function, ACE (angiotensin converting enzyme) inhibitors and calcium channel blockers are superior to alternative antihypertensive agents (nephroprotection).