Implications of ethnicity for the treatment of hypertensive kidney disease, with an emphasis on African Americans

Abstract

The recognition of chronic kidney disease (CKD) as an important public health issue has fostered an increasing number of strategies to increase CKD awareness and to reduce both the prevalence and the complications of CKD. Despite these advances, end-stage renal disease (ESRD) and cardiovascular events remain the major complications of CKD. Although the ESRD epidemic is attributed in greater part to the increasing rate of diabetes, hypertension remains the second most common reported cause of ESRD and is present in approximately 90% of cases of diabetes-related ESRD. The disproportionately high prevalence of hypertension in ethnic minorities, as well as the difficulty of achieving adequate blood-pressure control in these populations, contributes substantially to the high rate of CKD progression and complications in these groups. Although the role of hypertension as a primary cause of CKD is debated, hypertension is commonly recognized as the most important CKD progression factor. Important differences have been reported in the degree and likelihood of blood-pressure response to antihypertensive medications between ethnic groups, but ethnicity seems to be less important as a determinant of clinical outcomes. In this Review we examine key ethnic variations in hypertensive CKD in terms of pathophysiology, response to antihypertensive therapy, clinical outcomes, and evidence-based recommendations for blood-pressure control, with an emphasis on African Americans.

Hypertensive chronic kidney disease in African Americans: Strategies for improving care

“…17 Although these drugs may not lower blood pressure as much in low-renin hypertension as in high-renin hypertension, they may still afford the same cardiorenal protection.…”

Who should be prioritized for renal transplantation?: Analysis of key stakeholder preferences using discrete choice experiments

“…African Caribbeans and Asians have a 3–4 times greater risk of end stage renal disease [2] related to a higher prevalence of type 2 diabetes [4]. Increased risk of renal disease in these groups is also associated with increased risk of co-morbidities such as hypertension [5] and cardiovascular disease [6]. Moreover, ethnic minorities donate fewer organs [6], so individual patients are less likely to obtain closely matched transplants.…”

Association of candidate gene polymorphisms with chronic kidney disease in Japanese individuals with hypertension

“…Several risk factors for progression of CKD have been proposed, 4 with hypertension having been recognized as an important risk factor not only for CKD [5][6][7][8][9][10] but also for coronary heart disease and ischemic stroke. Genetic factors for predisposition to CKD in individuals with hypertension have, however, remained largely unknown.…”