Skip to main content

Advertisement

Log in

Effect of blood pressure lowering on markers of kidney disease progression

  • Published:
Current Hypertension Reports Aims and scope Submit manuscript

Abstract

Hypertension remains a common comorbidity and cause of chronic kidney disease (CKD). As the number of patients with CKD grows, so does the need to identify modifiable risk factors for CKD progression. Data on slowing progression of CKD or preventing end-stage renal disease with aggressive blood pressure control have not yielded definitive conclusions regarding ideal blood pressure targets. Shifting the focus of antihypertensive therapy to alternative markers of end-organ damage, specifically proteinuria, has yielded some promise in preventing the progression of CKD. Nevertheless, proteinuria and decline in estimated GFR may represent an irreversible degree of injury to the kidney that limits the impact of any therapy. The identification and use of novel markers of kidney injury to assess the impact of antihyper tensive therapy may yield clearer direction with regard to optimal management of hypertension in the setting of CKD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Abu Jawdeh BG, Rahman M: Blood pressure level and kidney disease progression: do we really need to go to 130/80 mm Hg? Curr Hypertens Rep 2009, 11:363–367.

    Article  PubMed  Google Scholar 

  2. Klag MJ, Whelton PK, Randall BL, et al.: Blood pressure and end-stage renal disease in men. N Engl J Med 1996, 334:13–18.

    Article  PubMed  CAS  Google Scholar 

  3. Hsu C, McCulloch CE, Darbinian J, et al.: Elevated blood pressure and risk for end-stage renal disease in subjects without baseline kidney disease. Arch Intern Med 2005, 165:923–928.

    Article  PubMed  Google Scholar 

  4. Klahr S, Levey AS, Beck GJ, et al.: The effects of dietary protein restriction and blood pressure control on the progression of chronic renal disease. N Engl J Med 1994, 330:877–884.

    Article  PubMed  CAS  Google Scholar 

  5. Peterson JC, Adler S, Burkart JM, et al.: Blood pressure control, proteinuria and the progression of renal disease—the Modification of Diet in Renal Disease Study. Ann Intern Med 1995, 123:754–762.

    PubMed  CAS  Google Scholar 

  6. Wright JT Jr, Bakris G, Greene T, et al.: Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 2002, 288:2421–2431.

    Article  PubMed  CAS  Google Scholar 

  7. Appel LJ, Wright JT Jr, Greene T, et al.: Long-term effects of renin-angiotensin system-blocking therapy and a low blood pressure goal on progression of hypertensive chronic kidney disease in African Americans. Arch Intern Med 2008, 168:832–839.

    Article  PubMed  CAS  Google Scholar 

  8. Toto RD, Mitchell HC, Smith RD, et al.: “Strict” blood pressure control and risk of renal disease in hypertensive nephrosclerosis. Kidney Int 1995, 48:851–859.

    Article  PubMed  CAS  Google Scholar 

  9. Lea J, Greene T, Hebert L, et al.: The relationship of magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American Study of Kidney Disease and Hypertension. Arch Intern Med 2005, 165:947–953.

    Article  PubMed  Google Scholar 

  10. UK Prospective Diabetes Study Group: Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. BMJ 1998, 317:703–713.

    Google Scholar 

  11. Lewis EJ, Hunsicker LG, Clarke WR, et al.: Renoprotective effect of the angiotensin receptor antagonist irbesartan in patients with nephropathy due to type 2 diabetes. N Engl J Med 2001, 345:851–860.

    Article  PubMed  CAS  Google Scholar 

  12. Atkins RC, Briganti EM, Lewis JB, et al.: Proteinuria reduction and progression to renal failure in patients with type 2 diabetes mellitus and overt nephropathy. Am J Kidney Dis 2004, 45:281–287.

    Article  Google Scholar 

  13. Brenner BM, Cooper ME, de Zeeuw D, et al.: Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy. N Engl J Med 2001, 345:861–869.

    Article  PubMed  CAS  Google Scholar 

  14. Bakris GL, Weir MR, Shanifar S, et al.: Effects of blood pressure level on progression of diabetic nephropathy: results from the RENAAL Study. Arch Intern Med 2003, 163:1555–1565.

    Article  PubMed  Google Scholar 

  15. de Galan BE, Perkovic V, Ninomiya T, et al.: Lowering blood pressure reduces renal events in type 2 diabetes. J Am Soc Nephrol 2009, 20:883–892.

    Article  PubMed  CAS  Google Scholar 

  16. The GISEN Group: Randomized placebo-controlled trial of effect of ramipril on decline in glomerular filtration rate and risk of terminal renal failure in proteinuric, non-diabetic nephropathy. Lancet 1997, 349:1857–1863.

    Article  Google Scholar 

  17. Esnault VLM, Brown EA, Apetrei E, et al.; Amlodipine Versus Enalapril in Renal Failure (AVER) Study Group: The effects of enalapril and amlodipine on renal function in adults with hypertension and non-diabetic nephropathies: a 3-year, randomized, multicenter, double-blind, placebocontrolled study. Clin Ther 2008, 30:482–498.

    Article  PubMed  CAS  Google Scholar 

  18. Richard S: Vascular effects of calcium-channel antagonists: new evidence. Drugs 2005, 65(Suppl 2):1–10.

    PubMed  CAS  Google Scholar 

  19. Martinez-Martin FJ, Saiz-Satjes M: Add-on manidipine versus amlodipine in diabetic patients with hypertension and microalbuminuria: the AMANDHA study. Expert Rev Cardiovasc Ther 2008, 6:1347–1355.

    Article  PubMed  CAS  Google Scholar 

  20. Fogari R, Corradi L, Zoppi A, et al.: Addition of manidipine improves the antiproteinuric effect of candesartan in hypertensive patients with type II diabetes and microalbuminuria. Am J Hypertens 2007, 20:1092–1096.

    Article  PubMed  CAS  Google Scholar 

  21. Bolignano D, Lacquaniti A, Coppolino G, et al.: Neutrophil gelatinase-associated lipocalin (NGAL) and progression of chronic kidney disease. Clin J Am Soc Nephrol 2009, 4:337–344.

    Article  PubMed  CAS  Google Scholar 

  22. Bolignano D, Lacquaniti A, Coppolino G, et al.: Neutrophil gelatinase-associated lipocalin as an early biomarker of nephropathy in diabetic patients. Kidney Blood Press Res 2009, 32:91–98.

    Article  PubMed  CAS  Google Scholar 

  23. Fliser D, Ritz E: Serum cystatin C concentration as a marker of renal dysfunction in the elderly. Am J Kidney Dis 2001, 37:79–83.

    PubMed  CAS  Google Scholar 

  24. Shilpak MG, Sarnak MJ, Katz R, et al.: Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med 2005, 352:2049–2060.

    Article  Google Scholar 

  25. Peralta CA, Whooley MA, Ix JH, Shilpak MG: Kidney function and systolic blood pressure: new insights from cystatin C: data from the Heart and Soul Study. Am J Hypertens 2006, 19:939–946.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jay L. Koyner.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Udani, S.M., Koyner, J.L. Effect of blood pressure lowering on markers of kidney disease progression. Current Science Inc 11, 368–374 (2009). https://doi.org/10.1007/s11906-009-0061-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11906-009-0061-2

Keywords

Navigation