Renoprotective effects of antihypertensive drugs

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Regardless of the specific antihypertensive agent used, the most important aspect of the management of the patient with coexistent hypertension and renal disease is adequate control of the blood pressure. The current JNC VI recommendation is for a reduction to a target blood pressure of 130/85 mm Hg, or to a lower value of 125/75 in patients with greater than 1 g proteinuria per day. Impaired renal sodium excretion leading to extracellular fluid volume (ECFV) expansion is the most clinically important mechanism leading to renal parenchymal hypertension. Sodium restriction and loop diuretics constitute the cornerstone of effective antihypertensive therapy. Control of blood pressure in patients with chronic renal disease may be difficult without measures that address ECFV. JNC VI recommends the use of angiotensin converting enzyme (ACE) inhibitors in patients with hypertension and chronic renal disease to control hypertension and to slow progressive renal failure. ACE inhibitors have been found by clinical trials to be useful agents in the settings of established insulin-dependent diabetes mellitus (IDDM) nephropathy, non-insulin-dependent diabetes mellitus (NIDDM) nephropathy, IDDM patients with normal blood pressures and microalbuminuria, NIDDM patients with microalbuminuria and normal renal function, and a variety of nondiabetic renal diseases, especially in the setting of significant proteinuria. Calcium antagonists are effective for treating hypertensive patients with chronic renal impairment but have not been studied as intensively as ACE inhibitors with regard to their ability to slow the progression of renal insufficiency independently of their blood-pressure- lowering effects. The initial results for calcium antagonists and for combination calcium antagonist-ACE inhibitor therapy have been promising. The angiotensin II antagonists have theoretical advantages for use in renal impairment, and seem to have similar renal hemodynamic and antiproteinuric effects to ACE inhibitors, but further clinical study is needed.

Original languageEnglish
JournalAmerican Journal of Hypertension
Volume12
Issue number1 II SUPPL.
StatePublished - Mar 17 1999

Fingerprint

Antihypertensive Agents
Angiotensin-Converting Enzyme Inhibitors
Blood Pressure
Kidney
Renal Hypertension
Extracellular Fluid
Calcium
Type 1 Diabetes Mellitus
Chronic Renal Insufficiency
Proteinuria
Type 2 Diabetes Mellitus
Renal Insufficiency
Sodium
Hypertension
Sodium Potassium Chloride Symporter Inhibitors
Enzyme Therapy
Angiotensin II
Hemodynamics
Clinical Trials

Keywords

  • Antihypertensive drugs
  • Renal disease
  • Renoprotection

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Renoprotective effects of antihypertensive drugs. / Preston, Richard A.

In: American Journal of Hypertension, Vol. 12, No. 1 II SUPPL., 17.03.1999.

Research output: Contribution to journalArticle

@article{67746dcfad084ec987e982b2a170ef9f,
title = "Renoprotective effects of antihypertensive drugs",
abstract = "Regardless of the specific antihypertensive agent used, the most important aspect of the management of the patient with coexistent hypertension and renal disease is adequate control of the blood pressure. The current JNC VI recommendation is for a reduction to a target blood pressure of 130/85 mm Hg, or to a lower value of 125/75 in patients with greater than 1 g proteinuria per day. Impaired renal sodium excretion leading to extracellular fluid volume (ECFV) expansion is the most clinically important mechanism leading to renal parenchymal hypertension. Sodium restriction and loop diuretics constitute the cornerstone of effective antihypertensive therapy. Control of blood pressure in patients with chronic renal disease may be difficult without measures that address ECFV. JNC VI recommends the use of angiotensin converting enzyme (ACE) inhibitors in patients with hypertension and chronic renal disease to control hypertension and to slow progressive renal failure. ACE inhibitors have been found by clinical trials to be useful agents in the settings of established insulin-dependent diabetes mellitus (IDDM) nephropathy, non-insulin-dependent diabetes mellitus (NIDDM) nephropathy, IDDM patients with normal blood pressures and microalbuminuria, NIDDM patients with microalbuminuria and normal renal function, and a variety of nondiabetic renal diseases, especially in the setting of significant proteinuria. Calcium antagonists are effective for treating hypertensive patients with chronic renal impairment but have not been studied as intensively as ACE inhibitors with regard to their ability to slow the progression of renal insufficiency independently of their blood-pressure- lowering effects. The initial results for calcium antagonists and for combination calcium antagonist-ACE inhibitor therapy have been promising. The angiotensin II antagonists have theoretical advantages for use in renal impairment, and seem to have similar renal hemodynamic and antiproteinuric effects to ACE inhibitors, but further clinical study is needed.",
keywords = "Antihypertensive drugs, Renal disease, Renoprotection",
author = "Preston, {Richard A}",
year = "1999",
month = "3",
day = "17",
language = "English",
volume = "12",
journal = "Journal of clinical hypertension",
issn = "0895-7061",
publisher = "Oxford University Press",
number = "1 II SUPPL.",

}

TY - JOUR

T1 - Renoprotective effects of antihypertensive drugs

AU - Preston, Richard A

PY - 1999/3/17

Y1 - 1999/3/17

N2 - Regardless of the specific antihypertensive agent used, the most important aspect of the management of the patient with coexistent hypertension and renal disease is adequate control of the blood pressure. The current JNC VI recommendation is for a reduction to a target blood pressure of 130/85 mm Hg, or to a lower value of 125/75 in patients with greater than 1 g proteinuria per day. Impaired renal sodium excretion leading to extracellular fluid volume (ECFV) expansion is the most clinically important mechanism leading to renal parenchymal hypertension. Sodium restriction and loop diuretics constitute the cornerstone of effective antihypertensive therapy. Control of blood pressure in patients with chronic renal disease may be difficult without measures that address ECFV. JNC VI recommends the use of angiotensin converting enzyme (ACE) inhibitors in patients with hypertension and chronic renal disease to control hypertension and to slow progressive renal failure. ACE inhibitors have been found by clinical trials to be useful agents in the settings of established insulin-dependent diabetes mellitus (IDDM) nephropathy, non-insulin-dependent diabetes mellitus (NIDDM) nephropathy, IDDM patients with normal blood pressures and microalbuminuria, NIDDM patients with microalbuminuria and normal renal function, and a variety of nondiabetic renal diseases, especially in the setting of significant proteinuria. Calcium antagonists are effective for treating hypertensive patients with chronic renal impairment but have not been studied as intensively as ACE inhibitors with regard to their ability to slow the progression of renal insufficiency independently of their blood-pressure- lowering effects. The initial results for calcium antagonists and for combination calcium antagonist-ACE inhibitor therapy have been promising. The angiotensin II antagonists have theoretical advantages for use in renal impairment, and seem to have similar renal hemodynamic and antiproteinuric effects to ACE inhibitors, but further clinical study is needed.

AB - Regardless of the specific antihypertensive agent used, the most important aspect of the management of the patient with coexistent hypertension and renal disease is adequate control of the blood pressure. The current JNC VI recommendation is for a reduction to a target blood pressure of 130/85 mm Hg, or to a lower value of 125/75 in patients with greater than 1 g proteinuria per day. Impaired renal sodium excretion leading to extracellular fluid volume (ECFV) expansion is the most clinically important mechanism leading to renal parenchymal hypertension. Sodium restriction and loop diuretics constitute the cornerstone of effective antihypertensive therapy. Control of blood pressure in patients with chronic renal disease may be difficult without measures that address ECFV. JNC VI recommends the use of angiotensin converting enzyme (ACE) inhibitors in patients with hypertension and chronic renal disease to control hypertension and to slow progressive renal failure. ACE inhibitors have been found by clinical trials to be useful agents in the settings of established insulin-dependent diabetes mellitus (IDDM) nephropathy, non-insulin-dependent diabetes mellitus (NIDDM) nephropathy, IDDM patients with normal blood pressures and microalbuminuria, NIDDM patients with microalbuminuria and normal renal function, and a variety of nondiabetic renal diseases, especially in the setting of significant proteinuria. Calcium antagonists are effective for treating hypertensive patients with chronic renal impairment but have not been studied as intensively as ACE inhibitors with regard to their ability to slow the progression of renal insufficiency independently of their blood-pressure- lowering effects. The initial results for calcium antagonists and for combination calcium antagonist-ACE inhibitor therapy have been promising. The angiotensin II antagonists have theoretical advantages for use in renal impairment, and seem to have similar renal hemodynamic and antiproteinuric effects to ACE inhibitors, but further clinical study is needed.

KW - Antihypertensive drugs

KW - Renal disease

KW - Renoprotection

UR - http://www.scopus.com/inward/record.url?scp=0033020275&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033020275&partnerID=8YFLogxK

M3 - Article

C2 - 10077416

AN - SCOPUS:0033020275

VL - 12

JO - Journal of clinical hypertension

JF - Journal of clinical hypertension

SN - 0895-7061

IS - 1 II SUPPL.

ER -