Pretreatment blood pressure reliably predicts progression of chronic nephropathies

Abstract

Pretreatment blood pressure reliably predicts progression of times after treatment administration are questionable. chronic nephropathies. Background. Random, nontimed blood pressure (BP) measurements in the outpatient clinic may fail to provide reliable information on actual daily BP control in renal patients on Progressive renal function deterioration occurs in most chronic antihypertensive therapy. forms of chronic nephropathy [1]. A recognized major Methods. In a cohort of 163 patients with proteinuric chronic nephropathies followed prospectively with repeated BP and determinant of renal injury in these circumstances is glomerular filtration rate (GFR) measurements, we compared arterial hypertension: the higher the levels of arterial baseline and follow-up pretreatment, morning ("trough," meablood pressure (BP), the greater the risk of a given pasured by standard procedures, and "0 minutes," measured by tient to develop renal failure in the long term [2, 3]. an automatic device) and post-treatment (120 minutes) mea-On the other hand, many clinical studies are available surements, with BP monitored up to 600 minutes after treatment administration. We then evaluated which BP value most indicating that BP reduction is protective [reviewed in reliably predicted GFR decline (⌬GFR) and progression to 4]. In most intervention trials aimed at evaluating the end-stage renal failure (ESRF) over a median (interquartile effect of different antihypertensive regimens on disease range) follow-up of 20 (9 to 25) months. progression to renal failure, reported values of arterial Results. GFR decline was more reliably predicted by systolic BP were random measurements in outpatient clinics, as compared with diastolic BP and by pretreatment as compared to post-treatment BP, regardless of the timing and which may lead to different results depending on the method of measurement, respectively. In particular, at the 120time BP is measured [5-8]. Actually, in some studies, minute baseline and follow-up measurements, systolic BP had BP was measured in the morning just before the adminisno predictive value in patients with less severe renal insuffitration of antihypertensive medication, when the residciency and baseline diastolic BP, regardless of the level of renal dysfunction. The BP predictive value was remarkably higher ual effect of treatment is minimal ("trough" BP) [9-11]. in ramipril than in conventionally treated patients. All follow-In a few others, the BP was measured shortly after the up-but no baseline-measurements reliably predicted the risk administration of the antihypertensive treatment, conof ESRF in the entire study group. ceivably when the medication has achieved the peak Conclusions. In patients with progressive chronic nephropaeffect [12]. However, most of the studies did not report thies, systolic BP and pretreatment morning BP measurements are the most reliable predictors of disease outcome and may the timing of BP measurements [5-8], which renders data serve to guide antihypertensive therapy in routine clinical ...

Progression of Renal Disease

“…However, what often has been demonstrated in these studies is a failure to obtain protection with CCB that is proportional to the BP reductions, rather than an achievement of disproportionate renoprotection with RAS blockade. The stronger correlation of progression with BP that is observed in the RAS blockade as compared with the control groups in such studies is consistent with these interpretations (97). This relative inferiority of a CCB-based regimen is likely to be particularly true in patients with advanced proteinuric CKD, such as the participants in the recently reported trial from China (80).…”

“…Given the fundamental lability of BP, which is exaggerated further in treated and untreated hypertensive individuals, more caution needs to be exercised in inferring BP independence solely on the basis of isolated and relatively infrequently measured clinic pressures, which additionally often are not controlled for the time of day and/or relationship to drug dosing (3,4,60,97). Such effects may be particularly important in patients with diabetes and/or hypertension, who often do not exhibit the normal nocturnal BP dip (60).…”

Induction of Glia Maturation Factor-β in Proximal Tubular Cells Leads to Vulnerability to Oxidative Injury through the p38 Pathway and Changes in Antioxidant Enzyme Activities

“…: 81-78-731-4416; Fax: 81-78-732-5161; E-mail: masaru@suma.kobe-wu.ac.jp. 1 The abbreviations used are: PT, proximal tubular; GMF-␤, glia maturation factor-␤; TNF-␣, tumor necrosis factor-␣; BSO, buthionine sulfoximine; PBS, phosphate-buffered saline; FCS, fetal calf serum; CuZn-SOD, copper/zinc-superoxide dismutase; Mn-SOD, manganesesuperoxide dismutase; MTS, 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium; TRITC, tetramethylrhodamine isothiocyanate; ROS, reactive oxygen species; DCFDA, 2Ј,7Ј-dichlorodihydrofluorescein diacetate; NBT, nitro blue tetrazolium; GPX, glutathione peroxidase; ANOVA, analysis of variance.2 Available at bodymap.ims.u-tokyo.ac.jp/. …”

“…In chronic nephropathies, proteinuria is reportedly one of the best predictors, independent of mean arterial blood pressure, for disease progression toward end-stage renal failure (1,2). Microalbuminuria, which features a small quantity of albumin only (30 -300 mg/24 h), is known as an important early sign of diabetic nephropathy (3,4) and of progressive renal function loss in a non-diabetic population (5).…”

Influência da hipertensão arterial na incidência de doença renal terminal em negros e mulatos portadores de glomerulonefrite

“…Estas questões são, em verdade, difíceis de serem avaliadas em estudos retrospectivos. Um estudo de coorte prospectivo mostrou evidência de que o nível de pressão arterial registrado pela manhã antes da utilização de anti-hipertensivos é um indicador do grau de controle durante o dia e um preditor do declínio da filtração glomerular 24 . O estudo Modification of Diet in Renal Disease (MDRD) forneceu dados permitindo estimar a influência do controle da HA sobre a função renal em negros e brancos portadores de nefropatias em geral, portanto, não restrito a pacientes com glomerulonefrites 25 .…”