The treatment of systemic hypertension in chronic renal disease is now most
ly based on the administration of drugs which are able to reduce proteinuri
a and to slow down the progressive functional deterioration. Angiotensin-co
nverting-enzyme inhibitors (ACEI), which lower both proteinuria and blood p
ressure, have emerged as drugs of choice in proteinuric patients with eithe
r normal renal function or mild to moderate chronic renal failure. In non p
roteinuric nephropathies no controlled studies exist demonstrating the supe
riority of ACEI over other drugs. In these conditions calcium antagonists m
ight also be used. The approach to patients with hypertension and renal dis
ease should always take into consideration the quality of the results that
are to be achieved. If the aim is to control blood pressure and to protect
other organs at risk, then a variety of drugs can be used. if the aim is to
reduce proteinuria and slow down progression, then ACEI, possibly associat
ed with calcium antagonists, are the drugs of choice.