Renal function: The Cinderella of cardiovascular risk profile

The presence of an altered renal function in essential hypertension, advanc ed heart failure (HF) and after a myocardial infarction (MI) is associated with higher cardiovascular morbidity, and mortality. Indices of altered ren al function (e.g., microalbuminuria, increased serum creatinine concentrati ons, decrease in estimated creatinine clearance or overt proteinuria) are i ndependent predictors of cardiovascular morbidity, and mortality in any, of the three clinical situations. These parameters should then be routinely e valuated in clinical practice. These facts have several therapeutic implica tions. First, although there is no evidence-based information on the level of blood pressure that confers optimal renal protection, levels substantial ly, lower than past recommendations are advisable, Second, hypertensive kid ney, damage should be prevented by, early treatment of hypertensive patient s, particularly those with microalbuminuria. Finally, to avoid further aggr avation of high cardiovascular risk, antihypertensive agents devoid of unwa nted metabolic side effects should be used for the treatment of hypertensiv e vascular damage, In HF, the combination of an angiotensin-converting enzy me (ACE) inhibitor and a beta-blocker seem to be the most renoprotective. R enal outcome is also improved by, ACE inhibition after an MI. Finally,, ren al and cardiovascular outcome seem to run in parallel in all these situatio ns. (J Am Coll Cardiol 2001;38:1782-7) (C) 2001 by the American College of Cardiology.