Renal and Heart Failure Interrelationship in Hypertension

Abstract

Hypertension (HTN) is a major risk factor for the development and progression of chronic kidney disease (CKD), irrespective of the cause of CKD. In patients with CKD, resistant hypertension, masked hypertension, and elevated nighttime blood pressure (BP) are all common and are associated with a lower glomerular filtration rate (GFR), higher levels of albuminuria, tubular dysfunction, and atrophy and interstitial fibrosis. There is mounting evidence that heart failure (HF) and CKD are conditions with a huge impact on healthcare. Well-known factors contribute to the development and progression of cardiac and renal dysfunction, such as age, hypertension, diabetes, and atherosclerotic vascular disease. Several mechanisms also contribute to damage in the heart and kidneys and accelerate progressive organ dysfunction. These mechanisms are the result of an interplay between hemodynamic, neurohormonal, and cardiovascular (CV) disease-associated mechanisms as well as local and systemic inflammation, activation of cellular immunity, oxidative stress, bone and mineral metabolism and acid–base metabolism, anemia, and sarcopenia. In individuals with both HF and renal dysfunction, a combined treatment for both the conditions should be administered, although in those for whom acute or chronic heart disease predominates, the main treatment should address the heart disease; in contrast, if the principal condition is acute or chronic renal disease, then this should be the first focus of treatment. Treatment of hypertension is a cornerstone in the prevention of both HF and CKD.