Hypertension and the progression of renal disease

The incidence of people starting dialysis in the United States continues to rise as does the cost to fund dialysis programs. All efforts thus far to a lter the incidence of renal disease have been less than successful. This is due, in part, to a failure to adequately lower and maintain blood pressure to levels now recognized as slowing renal disease progression, i.e., <130/ 85 mmHg, and <125/75 mmHg in those with proteinuria of >1g per day. It is a lso clear that reducing blood pressures without reducing proteinuria doesn' t maximally reduce cardiovascular events or renal disease progression. Anti hypertensive agents that reduce both blood pressure and proteinuria include ACE inhibitors, angiotensin receptor blockers, nondihydropyridine calcium antagonists, and beta blockers. Other agents have not been shown to have su ch a benifit. Interestingly, these classes of agents, when used either alon e or combined, have shown marked reduction in both cardiovascular events as well as renal disease progression. The average number of different types o f blood pressure medications needed to achieve the aforementioned levels of blood pressure control is 3.2 agents. Hopefully, if all primary care physi cians, as well as nephrologists, try to achieve such blood pressure goals, the high cardiovascular risk and incresing incidence of end-stage renal dis ease will be markedly attenuated.