Hypertension as a Risk Factor for Chronic Kidney Disease

Abstract

High BP can be either a cause or a consequence of CKD. Estimating the prevalence of CKD attributable to hypertension alone is difficult as individuals with presumed hypertensive nephrosclerosis are rarely biopsied, and strict clinical criteria are not routinely followed to make a diagnosis. The reported incidence and prevalence of ESRD owing to hypertension is, therefore, likely an overestimate because of alternative diseases that are undiagnosed or overlooked. However, a strong AbstractFive decades back, high blood pressure (BP) was considered as an essential malady and not a treatable condition. Gradually, evidences started accumulating through major trials and now hypertension is the most common comorbidity and a powerful risk factor for chronic kidney disease (CKD) and coronary artery disease (CAD) and an independent risk factor for CKD progression. Although hypertension is the second most common cause of end-stage renal disease, next to diabetes mellitus, only few patients of primary hypertension develop renal dysfunction. The risk of hypertensive nephrosclerosis is high in African americans, independent of age, sex, and prevalence of hypertension. The clear-cut benefits of lowering BP in CKD patients are renoprotection and reducing the risk of CV complications. The less clear is the optimal BP targets and the best method for measuring and achieving the targets. Recent evidences suggest a BP goal of <130/80 mmHg irrespective of age and proteinuria, despite controversies. Home BP monitoring is gaining importance and it should be emphasized in all hypertensive patients.