Importance of Blood Pressure Control in Chronic Kidney Disease

Abstract

Arterial hypertension together with proteinuria is one of the most important factors associated with the progression of both diabetic and nondiabetic chronic kidney disease. In this review, the role of hypertension and proteinuria in renal disease progression, the BP target that should be achieved to slow the progression of renal damage, and the influence of baseline and current proteinuria on the renoprotective effects of antihypertensive therapy are discussed thoroughly. The interaction between the renoprotective effects of specific antihypertensive agents-mostly angiotensin-converting enzyme inhibitors and angiotensin receptor blockers-and the level of achieved BP also are evaluated. The body of evidence provided by several studies emphasizes the importance of both lowering BP and inhibiting the renin-angiotensin system as specific goals for renal and cardiovascular protection in chronic kidney disease.J Am Soc Nephrol 17: S98 -S103, 2006S98 -S103, . doi: 10.1681 C hronic kidney disease (CKD) is a worldwide public health problem. In the United States, there is an increasing incidence and prevalence of renal failure with poor outcome and high costs and an even higher prevalence of earlier stages of CKD (approximately 80 times greater than ESRD prevalence). Moreover, CKD is associated with elevated cardiovascular morbidity and mortality (1). Therefore, strategies that are aimed at identifying, preventing, and treating CKD and its related risk factors are needed.In the following sections, we focus on the role of hypertension and proteinuria as both independent and interdependent risk factors for renal disease progression. We also discuss BP targets that should be achieved to slow the progression of renal damage, the influence of baseline and current proteinuria on the renoprotective effects of antihypertensive therapy, and the interaction between the renoprotective action of specific antihypertensive agents-mostly angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB)-and the level of achieved BP. Role of Hypertension and Proteinuria on the Progression of Renal DiseaseHigh BP can be either a cause or a consequence of CKD. High BP may develop early in the course of CKD and can be associated with adverse outcomes such as worsening renal function and development of cardiovascular disease. Hypertension is a major promoter of the decline in GFR in both diabetic and nondiabetic kidney disease (2,3). Furthermore, large, observational, prospective trials in the general population showed that hypertension is a strong independent risk factor for ESRD. A strong relationship was observed between both systolic (SBP) and diastolic BP (DBP) and ESRD, regardless of other known risk factors, in men who were recruited in the Multiple Risk Factor Intervention Trial. The relative risk (RR) for ESRD was Ͼ20-fold higher for patients with stage 4 hypertension (SBP Ͼ 210 mmHg or DBP Ͼ 120 mmHg) than for patients with optimal BP levels (SBP Ͻ 120 mmHg and DBP Ͻ 80 mmHg) (4). The recent study by the Oki...

Potential Therapeutic Role of Phosphodiesterase Type 5 Inhibition in Hypertension and Chronic Kidney Disease

“…55 Blocking the renin-angiotensinaldosterone system, using angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, is the current gold standard treatment approach for hypertension and proteinuria in CKD. 56 These agents act not only to lower BP but also through a BP-independent effect on proteinuria and intrarenal pathology. 55,57 However, alternative pharmacological agents are emerging as future candidates.…”

Evaluating Cardiovascular Risk in Chronic Kidney Disease Patients: A Biomarker Approach

“…Hypertension is well established risk factor for artherosclerotic diseases including coronary artery disease, ischaemic stroke and peripheral vascular disease. Hypertension is frequently associated with CKD and it can be the cause or the consequence of CKD (Ravera et al 2006). Controlling blood pressure especially systolic blood pressure can be difficult in CKD patients (Coresh et al 2001;Ravera et al 2006;Tonelli et al 2001).…”

“…Hypertension is frequently associated with CKD and it can be the cause or the consequence of CKD (Ravera et al 2006). Controlling blood pressure especially systolic blood pressure can be difficult in CKD patients (Coresh et al 2001;Ravera et al 2006;Tonelli et al 2001). Most CKD patients are volume overload (Hung et al 2014;Wieskotten et al 2008) and it is a risk factor for CVD.…”

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“…20 The control of blood pressure, therefore, remains an important step in delaying the onset of end-stage renal disease and should be addressed seriously. 21,22 To this end, successful attempts at modifying the human genome have paved the way to gene editing and the correction of genetic defects, opening new avenues in our efforts at preventing end-stage renal disease. 23 Efforts to avoid the need for retransplant Ensuring the absolute success of all transplant procedures is obviously a utopia.…”