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Treatment of Hypertensive Patients with Chronic Renal Insufficiency

  • Samuel Spitalewitz
  • Jerome G. Porush
Chapter
Part of the Current Clinical Practice book series (CCP)

Abstract

The prevalence of hypertension in patients with chronic renal insufficiency (CRI) from all causes increases linearly as renal function deteriorates, reaching approx 95% as patients approach end-stage renal disease (ESRD) (1–3). There is now substantial evidence that controlling blood pressure (BP) will slow the inexorable decline in renal function in patients with CRI (4). Nevertheless, at a time when morbidity and mortality from cardiovascular disease is declining, the incidence of ESRD is increasing dramatically, particularly in African Americans, the elderly, and diabetics (5). There is no single explanation for this fact, but pertinent issues are as follows (6, 7):
  1. 1.

    Should the general therapeutic approach to hypertension (nonpharmacologic and/or pharmacologic) differ in patients with CRI vs essential hypertensive patients without renal insufficiency?

     
  2. 2.

    Will lowering BP to levels below current standards (140/90 mmHg; mean arterial pressure [MAP] = 107) better preserve renal function without increasing adverse consequences?

     
  3. 3.

    Are there specific classes of antihypertensive drugs that are renoprotective over and above their effect on BP?

     

Keywords

Diabetic Nephropathy Chronic Renal Insuf Urinary Protein Excretion Joint National Committee Goal Blood Pressure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Samuel Spitalewitz
  • Jerome G. Porush

There are no affiliations available

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