Reducing cardiovascular morbidity and mortality from hypertension in end-stage renal disease

Hypertension typically worsens with declining renal function, and is an alm ost universal feature of end-stage renal disease. Treating hypertension cle arly reduces the likelihood of cardiovascular disease in nonrenal populatio ns, with greater absolute benefit in those who have greater severity of und erlying cardiovascular disease. Patients with chronic renal diseases are at enormous cardiovascular risk. Although our approach to hypertension in pat ients with early renal insufficiency has become more aggressive, the ration ale has switched over the past decade from cardiovascular risk reduction to slowing the loss of renal function. Reliance on observational studies, esp ecially using mortality as the outcome, has not allowed a consistent, ratio nal approach to the treatment of hypertension in dialysis patients. Curr Op in Nephrol Hypertens 9:497-500. (C) 2000 Lippincott Williams & Wilkins.