NEPHROPROTECTIVE EFFECT OF ANTIHYPERTENSIVE DRUGS IN ESSENTIAL-HYPERTENSION

Background Effective antihypertensive treatment has prevented target-o rgan involvement in hypertension, markedly reducing morbidity and mort ality from strokes, coronary heart disease, cardiac failure, and hyper tensive emergencies. However, the incidence of hypertension-related en d-stage renal disease continues to increase, suggesting that therapeut ic reduction in arterial pressure by itself is not sufficient to preve nt the development of hypertensive renal failure. Objective To examine experimental and clinical data concerning the protective effect of re duction of arterial pressure on the progression of hypertension-relate d renal disease, and the evidence indicating that some antihypertensiv e agents may afford more nephroprotection, over and above that attribu table to reduction of arterial pressure. Results Results of numerous s tudies clearly indicate that adequate control of arterial pressure, ir respective of the antihypertensive agent used, slowed the progression of renal disease. Results of some studies suggest that lowering arteri al pressure below the level that is usually considered adequate has an additional beneficial effect by slowing the progression of renal inju ry. Conclusion Results of a number of studies evaluating nephroprotect ive effects of various drugs and regimens have indicated that certain agents, most notably angiotensin converting enzyme inhibitors and thei r combination with calcium antagonists, afford more protection than do others at similar levels of reduction of arterial pressure. Results o f still other studies suggest that certain agents that exert greater n ephroprotection are more efficient at controlling arterial pressure. T herefore, further data are needed before any final conclusion can be d rawn. However, it is clear that, in order to establish nephroprotectio n in patients with essential hypertension, the problem should not be f urther complicated by additional comorbid diseases such as diabetes me llitus. (C) 1998 Lippincott-Raven Publishers.