Evolution of drugs that preserve renal function

Over the past 50 years, many advances have been made in slowing the progres sion of renal disease from various causes. These advances have been primari ly linked to defining new lower levels for blood pressure goals as well as understanding the importance of proteinuria reduction. To achieve these goa ls, if is also appreciated that agents that lower blood pressure must also lower proteinuria. This is not true for all antihypertensive drug classes-n otably, direct-acting vasodilators, alpha-blockers, and dihydropyridine cal cium antagonists. Interestingly, antihypertensive agents that also reduce p roteinuria have been associated with cardiovascular risk reduction. Moreove r, an understanding of combinations of antihypertensive medications that pr ovide additive reductions in proteinuria may be even more efficacious for s lowing renal disease progression. It is hoped that these advances and the p rojected advances in pharmacogenetics will reduce the current increasing in cidence of people going on dialysis. (C)2000 the American College of Clinic al Pharmacology.