Long-term improvement in renal function after short-term strict blood pressure control in hypertensive nephrosclerosis.

Abstract

Seventy-nine hypertensive nephrosclerosis patients i entered a prospective randomized singleblind study to 1) establish the pattern of decay of renal function in this population and the variability therein and 2) to determine if strict diastolic blood pressure (DBP) control (<80 mm Hg) is more effective than conventional levels (90-95 mm Hg) in conserving renal function. Because of unexpected significant improvement in renal function in patients from both groups, which changed the perspectives on the course of this disease as described herein, this report is being published before completion of the trial. The selection criteria were 1) serum creatinine concentration of 1.6-7.0 mg/dl, 2) glomerular filtration rate of less than 70 ml/min/1.73 m 2 , and 3) absence of diseases (other than hypertension) known to destroy renal function. Renal function was assessed by glomerular filtration rate ([ l2S I]iothalamate clearance) and serum creatinine concentration. Before randomization, DBP was aggressively treated to reduce it to less than 80 mm Hg. Twenty-two subjects (14 in the strict DBP control group and eight in the conventional DBP control group) have been enrolled in the study for 36 months. In contrast to results from previous studies in humans and rats, renal function improved in both patient groups. Thus, irrevocable progression of renal damage after onset of renal failure from high blood pressure does not necessarily occur, and in fact, long-term improvement of renal function resulted from the effects of the study itself. The study design involving the 2-4-month initial period of aggressive DBP control at 80 mm Hg or less followed by control of DBP at less than 90 mm Hg was associated with long-term improvement in renal function. (Hypertension 1989; 13:766-772)

Chronic Nephropathies of Cocaine and Heroin Abuse

“…Illicit drug use, however, was not found to be a risk factor for severe hypertension in a black and Hispanic population (93). Despite the plausible putative effects of cocaine on the kidney and vasculature, medical noncompliance and socioeconomic factors may contribute to the increased risk for renal deterioration in hypertensive black individuals (94,95). Diagnoses of hypertension-related ESRD often are made on clinical grounds alone, so the validity of reported causes of ESRD may be uncertain without verification by renal biopsy (92).…”

Essential hypertension: a renal disease? A review and update of the evidence.

“…In contrast, in a study over several years but with patient groups partially separated into two levels of target blood pressure, GFR was apparently maintained by therapy that included minoxidil. 85 Several retrospective studies have shown no evidence of renal protection by apparently effective antihypertensive treatment, especially in African-Americans. 86 " 89 In an important analysis of the Multiple Risk Factor Intervention Trial (MRFIT), admittedly using reciprocal serum creatinine measurements but over 8 years and with well-documented good control of blood pressure (to 132/87 mm Hg in the "usual care" group and 121/82 mm Hg in the "special intervention" group), Walker and coworkers 89 demonstrated protection of renal function in white but not in black subjects.…”

Management of Chronic Kidney Disease in an Academic Primary Care Clinic

“…However, the clinical literature had already suggested the importance of diabetes management [11], blood pressure control [12][13][14][15], angiotensin-converting enzyme inhibition (ACEI) [16], anemia management [17,18], management of calcium metabolism [19][20][21], and timely referral to nephrologist [4,5,22].…”