TREATMENT OF HYPERTENSION IN CHRONIC RENAL-INSUFFICIENCY

Several trials clearly demonstrate the importance of correcting hypert ension and proteinuria in slowing chronic renal insufficiency (CRI) pr ogression The relationship between hypertension and CRT is at least pa rtly the consequence of impaired renal hemodynamics, mainly mediated b y the renin-angiotensin system, Two classes of drugs have so far been shown to have an antiproteinuric and renoprotective effect, in additio n to their antihypertensive action: ACE inhibitors and calcium-channel blockers (at least the non-dihydropyridines) which also interfere wit h the actions of angiotensin II. The same should be true for the newes t angiotensin II receptor antagonists, To find conclusive evidence abo ut the superior renoprotective effect of ACE inhibitors (or angiotensi n II receptor antagonists) or calcium-channel blockers, we need well-d esigned, prospective, controlled and randomized long-term trials; the pharmacological rationale for combining the two classes of antihyperte nsive drugs is supported by the clinical need to reach a target blood pressure (120/80 mmHg) in CRI patients with proteinuria.