Kidney disease may be the cause or a consequence of hypertension. Hypertension affects 25% of the adult population in the United States. Similarly, chronic kidney disease (CKD) and end-stage renal disease (ESRD) have been steadily increasing in incidence because of the increasing age of the US population and rise in the incidence of risk factors, including hypertension. Substantial evidence supports the notion that elevated blood pressure is the most significant risk factor for developing CKD. Microalbuminuria has been shown to be the early marker of hypertensive renal disease. Furthermore, therapy to reduce microalbuminuria was associated with delayed progression of renal disease. Black Americans are at higher risk for developing hypertensive nephrosclerosis than whites. Hypertension is a major risk factor for cardiovascular events in patients with CKD and ESRD and those who have undergone renal transplantation. Studies have documented that elevated serum creatinine and CKD are risk factors for a cardiovascular event. Tight blood pressure control has been shown to reduce microalbuminuria and proteinuria and to delay progression of renal disease. Tailoring antihypertensive medication to the clinical setting to achieve a blood pressure goal is critical in reducing complications from this deadly connection.
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References and Recommended Reading
Sowers JR, Epstein M, Frolich E: Diabetes, hypertension and cardiovascular disease: an update. Hypertension 2001, 37:1053–1059.
Douglas JG: Clinical guidelines for the treatment of hypertension in African Americans. Am J Cardiovasc Drugs 2005, 5:1–6.
Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003, 42:1206–1252.
Kidney Disease Outcome Quality Initiative (K/DOQI): K/Doqi Clinical Practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004, 43(Suppl 1):S1–S290.
Mann JF, Gerstein HC, Pogue J, et al.: Renal insufficiency as a predictor of cardiovascular outcomes and the impact of Ramipril: the HOPE randomized trial. Ann Intern Med 2001, 134:629–636.
Shulman NB, Fold CE, Hall WD, et al.: Prognostic value of serum creatinine and effect of treatment of hypertension on renal function. Results from the Hypertension Detection and Follow-up Program Cooperative Group. Hypertension 1989, 13(Suppl 5):180–193.
Walker WG, Neaton JD, Cutler JA, et al.: Renal function change in hypertensive members of the Multiple Risk Factors Intervention Trial. Racial and treatment effects. The MRFIT Research Group. J Am Med Assoc 1992, 268:3085–3091.
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.
Bakris GL, William M, Dworkin L, et al., for the National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group: Preserving kidney function in adults with hypertension and diabetes: a consensus approach. Am J Kidney Dis 2000, 36:646–661.
Perry HM Jr, Miller JP, Fornoff JR, et al.: Early predictors of 15-year end-stage renal disease in hypertensive patients. Hypertension 1995, 25:587–594.
Bakris GL, Weir MR, Shanifar S, et al., for the RENAAL Study Group: Effects of blood pressure level on progression of diabetic nephropathy: results from the RENAAL Study. Arch Intern Med 2003, 163:1555–1565.
Shrier RW, Estacio RO, Esler A, et al.: Effects of aggressive blood pressure control in normotensive type 2 diabetic patients on albuminuria, retinopathy and strokes. Kidney Int 2002, 61:1086–1097.
Parving H, Lehnert H, Rochner-Mortensen J, et al.: The effect of irbesartan in the development of diabetic nephropathyin patients with type 2 diabetes. N Engl J Med 2001, 345:570–578.
Weir MR: The role of combination antihypertensive therapy in the prevention and treatment of chronic kidney disease. Am J Hypertens 2005, 18:100S–105S.
Hsu CY, Lin F, Vittinghoff E, et al.: Racial difference in the progression from chronic renal insufficiency to end-stage renal disease in the United States. J Am Soc Nephrol 2003, 14:565–570.
Wright JT Jr, Kusek JW, Toto RD, et al.: Design and baseline characteristics of participants in the African-American Study of Kidney disease and Hypertension. Clin Trials 1996, 17(4 Suppl):3S–16S.
Klahr S, Levy AS, Beck GJ, et al.: The effects of dietary protein restriction and blood pressure control on the progression of chronic renal disease. Modification of Diet in Renal Disease Study Group. N Engl J Med 1994, 330:877–884.
Freedman BI, Bowden DW, Rich SS, et al.: Genetic initiation of hypertensive and diabetic nephropathy. Am J Hypertens 1998, 11:251–257.
Keller G, Zimmer G, Mall G, et al.: Nephron number in patients with primary hypertension. N Engl J Med 2003, 348:101–108.
Toto RD: Hypertensive nephrosclerosis in African Americans. Kidney Int 2003, 64:2331–2341.
American Diabetes Association: Prevention or delay of type 2 diabetes. Diabetes Care 2004, 27(Suppl 1):S47–S54.
Bjorck S, Mulec H, Johnson SA, et al.: Renal protective effect of enalapril in diabetic nephropathy. BMJ 1992, 304:339–343.
Mascjio G, Alberti O, Janin G, et al., for the Angiotensin-Converting Inhibitor Group: Effect of angiotensin converting enzyme inhibitor benazepril on the progression of chronic renal insufficiency. N Engl J Med 1996, 334:939–945.
Dzau VJ: Theodore Cooper Lecture: tissue angiotensin and the pathogenesis of vascular disease: a unifying hypothesis. Hypertension 2001, 37:1047–1052.
Jacobsen P, Anderson S, Rossing K, et al.: Dual blockade of the renin angiotensin system versus maximal recommended dose of ACE inhibition of diabetic nephropathy. Kidney Int 2003, 63:1874–1880.
Rossing K, Christensen PK, Jensen BR, et al.: Dual blockade of the rennin angiotensin in diabetic nephropathy: a randomized double-blind crossover study. Diabetes Care 2002, 63:1094–1103.
Nakao N, Yoshimura A, Morita H, et al.: Combination treatment of angiotensin II receptor blocker and angiotensinconverting-enzyme inhibitor in non diabetic renal disease (COOPERATE): a randomized controlled trial. Lancet 2003, 361:117–124.
Rocco MV, Yan G, Heyka RJ, et al.: Risk factors for hypertension in chronic hemodialysis patients: baseline data from the HEMO study. Am J Nephrol 2001, 21:280–288.
Agarwal R, Niesenson AR, Batlle D, et al.: Prevalence, treatment and control of hypertension in hemodialysis patients in the United States. Am J Med 2003, 115:291–297.
Post FK, Hulbert-Shearon TE, Wolfe RA, et al.: Pre-dialysis blood pressure and mortality risk in a national sample of maintenance hemodialysis patients. Am J Kidney Dis 1999, 33:507–517.
Zager PG, Nikolic J, Brown RH, et al.: “U” curve association of blood pressure and mortality in hemodialysis patients. Medical Directors of Dialysis Clinic, Inc. Kidney Int 1998, 54:561–569.
Liu M, Takahashi H, Morita Y, et al.: Non-dipping is a potent predictor of cardiovascular mortality and is associated with autonomic dysfunction in hemodialysis patients. Nephrol Dial Transplant 2003, 18:563.
First MR, Neylan JF, Rocher LL, et al.: Hypertension after renal transplantation. J Am Soc Nephrol 1994, 4(Suppl 1):30–36.
Texter SC, Canzanello VJ, Talor SJ, et al.: Cyclosporine-induced hypertension after transplantation. Mayo Clin Proc 1994, 69:1182–1193.
Veenstra DL, Best JH, Hornberger J, et al.: Incidence and long-term cost of steroid related side effects after renal transplantation. Am J Kidney Dis 1999, 33:829–839.
Opelz G, Wujciak T, Ritz E: Association of chronic kidney graft failure with recipient blood pressure. Kidney Int 1998, 53:217–222.
Ruggenenti P, Perico N, Mosconi L, et al.: Calcium channel blockers protect transplant patients from cyclosporine induced daily renal hypoperfusion. Kidney Int 1993, 43:706–711.
Midtvedt K, Hartmann A: Hypertension after kidney transplantation: are treatment guidelines emerging. Nephrol Dial Transplant 2002, 17:1166–1169.
Midtvedt K, Hartmann A, Foss A, et al.: Sustained improvement of renal graft function for 2 years in hypertensive renal transplant recipients treated with nifedipine compared to lisinopril. Transplantation 2001, 72:1787–1792.
Olyaei AS, deMottos AM, Bennett WM: A practical guide to the management of hypertension in renal transplant recipients. Drugs 1999, 58:1011–1027.
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Barri, Y.M. Hypertension and kidney disease: A deadly connection. Current Science Inc 10, 39–45 (2008). https://doi.org/10.1007/s11906-008-0009-y