Importance of blood pressure reduction for prevention of progression of renal disease

Current Hypertension Reports

Volumn 1, Issue 5, 1999, Pages 423-430

  Textor, Stephen C ^a   Canzanello, Vincent J ^a  

^a MAYO CLINIC   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ANTIHYPERTENSIVE AGENT;

ARTICLE; BLOOD PRESSURE; DISEASE COURSE; DRUG EFFECT; HUMAN; HYPERTENSION; KIDNEY DISEASE; PATHOPHYSIOLOGY; PHYSIOLOGY; PROGNOSIS;

ANTIHYPERTENSIVE AGENTS; BLOOD PRESSURE; DISEASE PROGRESSION; HUMANS; HYPERTENSION; KIDNEY DISEASES; PROGNOSIS;

EID: 0033205348     PISSN: 15226417     EISSN: 15343111     Source Type: Journal    
DOI: 10.1007/s11906-999-0059-9     Document Type: Article

References (48)

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39. Hansson L, Zanchetti A, Carruthers SG, et al.: Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results in the Hypertension Optimal Treatment (HOT) randomised trial. Lancet 1998, 351:1755-1762.
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41. Klahr S: Prevention of progression in nephropathy. Nephrol Dial Transplant 1997, 12(suppl 2):63-66.
42. Hebert LA, Kusek JW, Greene T, et al.: Effects of blood pressure control on progressive renal disease in blacks and whites. Hypertension 1997, 30(part 1):428-435. Subset analysis of MDRD trial comparing black patients with whites patients: 53 black versus 495 white patients with a glomerular filtration rate (GFR) between 25 and 55 mL/min; 28% of black patients had hypertension as the primary renal diagnosis (vs 16% of white patients). The authors claim that in black patients only, an overall lower rate of GFR decline was noted with low blood pressure (65%), although this was blunted by reduced GFR in first months of trial. Despite limited numbers, overall conclusion is supportive of vigorous antihypertensive therapy in black patients to retard disease progression, at least until results of AASKD are available. Most striking effects were observed in those with high urine protein, consistent with overall trial results.
43. Toto RD, Mitchell HC, Smith RD, et al.: "Strict" blood pressure control and progression of renal disease in hypertensive nephrosclerosis. Kidney Int 1995, 48:851-859.
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45. Tuomilehto J, Rastenyte D, Birkenhager WH, et al.: Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension. N Engl J Med 1999, 340:677-684.
46. Berlowitz DR, ASh AS, Hickey EC, et al.: Inadequate management of blood pressure in a hypertensive population. N Engl J Med 1998, 339:1957-1963. Evaluation of 800 veterans over 2 years: mean age, 65.5years; 40% had blood pressure > 160/90 mm Hg, despite more than six blood presure-related visits. Only 6.7% had increased therapy during this period; these patients had a blood pressure reduction by 6.3 mm Hg, whereas less intensive Rx was associated with a 4.8 mm Hg rise in blood pressure. The authors argue that these data reflected a failure on the part of physicians to aggressively treat hypertension. Note: 59% were on two or more drugs.
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