Prognostic significance of a reduced glomerular filtration rate and interaction with microalbuminuria in resistant hypertension

Salles, Gil F.; Cardoso, Claudia R.L.; Pereira, Vinícius Carvalho; Fiszman, Roberto; Muxfeldt, Elizabeth Silaid

doi:10.1097/hjh.0b013e32834adb09

Cited by 36 publications

(23 citation statements)

References 39 publications

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“…One area where data are particularly limited is the effect of renal function on the blood pressure response to these forms of global and renal-specific sympathoinhibition seen with BA and renal nerve ablation, respectively. This is due in large part to the fact that despite the prevalence of chronic kidney disease (CKD) in patients with RHT, 1,9–14 most clinical trials using device-based therapy have been limited to patients with little or no impairment in kidney function. 6–8 These patients have been excluded from clinical trials for fear of worsening renal injury due to reductions in renal perfusion pressure and/or theoretical safety concerns regarding damage to the renal artery in the case of renal nerve ablation.…”

Section: Introductionmentioning

confidence: 99%

“…The paucity of data from these patients may be especially significant because the presence of CKD is not only often associated with RHT but is also a strong predictor of RHT and is a risk marker for adverse cardiovascular and renal outcomes. 1,9–14 Although optimal blood pressure control is likely critical in reducing the development and progression of renal disease in patients with RHT, it remains unclear whether device-based therapies can effectively lower arterial pressure without further exacerbating renal injury in patients with RHT and coexistent CKD.…”

Section: Introductionmentioning

confidence: 99%

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Prolonged Baroreflex Activation Abolishes Salt-Induced Hypertension After Reductions in Kidney Mass

2016

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Chronic electric activation of the carotid baroreflex produces sustained reductions in sympathetic activity and arterial pressure and is currently being evaluated for therapy in patients with resistant hypertension. However, patients with significant impairment of renal function have been largely excluded from clinical trials. Thus, there is little information on blood pressure and renal responses to baroreflex activation in subjects with advanced chronic kidney disease, which is common in resistant hypertension. Changes in arterial pressure and glomerular filtration rate were determined in 5 dogs after combined unilateral nephrectomy and surgical excision of the poles of the remaining kidney to produce ~ a 70% reduction in renal mass. After control measurements, sodium intake was increased from ~45 to 450 mol/day. While maintained on high salt, animals experienced increases in mean arterial pressure from 102±4 to 121±6 mmHg and GFR from 40±2 to 45±2 mL/min. During 7 days of baroreflex activation the hypertension induced by high salt was abolished (103±6 mmHg) along with striking suppression of plasma norepinephrine concentration from 139±21 to 81±9 pg/mL, but despite pronounced blood pressure lowering there were no significant changes in GFR (43±2mL/min). All variables returned to pre-stimulation values during a recovery period. These findings indicate that after appreciable nephron loss, chronic suppression of central sympathetic outflow by baroreflex activation abolishes hypertension induced by high salt intake. The sustained antihypertensive effects of baroreflex activation occur without significantly compromising glomerular filtration rate in remnant nephrons.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prolonged Baroreflex Activation Abolishes Salt-Induced Hypertension After Reductions in Kidney Mass

2016

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“…It should be clearly understood that RH in patients with CKD predisposes to serious adverse cardiorenal outcomes [33,34]. RH is a powerful harbinger of adverse prognosis in patients with CKD [35,36].…”

Section: Rh In Patients With Ckd: Significance and Prognosismentioning

confidence: 99%

Resistant Hypertension in Patients with Chronic Kidney Disease

Wali¹,

Naik²,

Ram³

2014

Chronic Kidney Disease and Hypertension

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“…Higher prevalence of subclinical organ damage can be found in patients with resistant hypertension, including left ventricular hypertrophy [18], intima-media thickening and carotid atheroma [19], hypertensive retinopathy, albuminuria and initial impairment of renal function [20,21].…”

Section: Prognosismentioning

confidence: 99%

Clinical Management of Resistant Hypertension

Veglio

Mancia

Volpe

2013

High Blood Press Cardiovasc Prev

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According to recent hypertension guidelines, resistant hypertension is a clinical condition characterized by the presence of BP values above the recommended limits of the reference values (BP >140/90 mmHg). The prevalence of this clinical condition is about 10 % of the essential hypertensives. A proper diagnosis and management of resistant hypertension should go trough careful, mandatory clinical step, aimed at excluding the presence of pseudo-resistance hypertension. In this report, we summarized the practical recommendations are targeting both the general practitioner and the specialist who play an active role in the clinical management of patients with arterial hypertension.

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Prognostic significance of a reduced glomerular filtration rate and interaction with microalbuminuria in resistant hypertension

Abstract: A reduced GFR, mainly estimated by the MDRD equation, is an independent predictor of increased cardiovascular morbidity and mortality in resistant hypertension. The combination of a reduced GFR and increased albuminuria identifies patients with a very high cardiovascular risk.

Cited by 36 publications

References 39 publications

Prolonged Baroreflex Activation Abolishes Salt-Induced Hypertension After Reductions in Kidney Mass

Prolonged Baroreflex Activation Abolishes Salt-Induced Hypertension After Reductions in Kidney Mass

Resistant Hypertension in Patients with Chronic Kidney Disease

Clinical Management of Resistant Hypertension

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