PREVENTION OF CARDIOVASCULAR-DISEASE IN HYPERTENSIVE PATIENTS WITH NORMAL RENAL-FUNCTION

Hypertension is an important risk factor for cardiovascular disease (C VD) In patients with normal renal function. After reviewing over two d ecades of clinical trial data and an even longer history of epidemiolo gic data, multiple consensus panels worldwide have made recommendation s for the aggressive treatment of hypertension using both lifestyle mo dification and drug therapy These data and recommendations provide the basis of the recommendations for preventing CVD in patients with rena l disease. Most patients should have elevated blood pressure (BP) lowe red to less than 140 mm Hg systolic and less than 90 mm Hg diastolic, Earlier and more aggressive intervention is recommended in high-risk h ypertensive patients with risk factors (especially diabetes mellitus) or evidence of target organ damage or clinical CVD. Lifestyle changes are indicated as either Initial therapy or concomitant therapy in all hypertensive patients to lower BP and to normalize other CVD risk fact ors. There is general agreement that clinical outcome data from contro lled clinical trials should guide the selection of antihypertensive ag ents, Currently, these data are only available for thiazide diuretics and beta-blockers for most hypertensive patients with normal renal fun ction and for the dihydropyridine calcium channel blockers in older hy pertensive patients with isolated systolic hypertension, However, data may support the use of other agents in hypertensives with selected co morbidity (eg, ACE inhibitors in heart failure, beta-blockers after my ocardial infarction, and so forth). However, with only 25% of hyperten sive patients controlled to less than 140/90 mm Hg, achieving blood pr essure control remains the most important goal in managing hypertensio n in this population. (C) 1998 by the National Kidney Foundation, Inc.