Prevention of Hypertension and Its Complications

Abstract

Abstract. Hypertension is a nutritional-hygienic disease. Longterm caloric intake in excess of energy expenditures, chronic supraphysiological intake of dietary sodium, excessive alcohol consumption, and psychosocial stressors all contribute to the development of hypertension throughout the world. Elevated BP, particularly systolic BP, has been linked to multiple adverse clinical outcomes including stroke, heart failure, myocardial infarction, renal insufficiency/failure, peripheral vascular disease, retinopathy, dementia, and premature mortality. These undesirable clinical outcomes are typically, although not invariably, preceded by pressure-related target-organ injury such as left ventricular hypertrophy, renal insufficiency and proteinuria. The relation of BP and CKD and, in turn, the prevention of CKD or forestalling its progression by hypertension treatment, will be the focus of this manuscript. In hypertensive persons with reduced kidney function and/or proteinuria, lowering BP with multidrug therapy that is inclusive of pharmacologic modulators of the renin-angiotensin-aldosterone-kinin system is an effective strategy to forestall the progressive loss of kidney function. The totality of data support low therapeutic BP targets for persons with proteinuria Ͼ1 g/d.Nevertheless, in persons with CKD, even those with proteinuria below the dipstick positive level (approximately 300 mg/d or urine protein to creatinine ratio of 0.22), aggressive BP control also may be warranted because of the high risk of nonrenal cardiovascular disease. Multiple antihypertensive drugs will be required in the vast majority of patients with diabetes and/or reduced kidney function to attain BP goal. Renin-angiotensin system (RAS) modulator therapy is indicated among persons with diabetes mellitus and CKD. Available data support the use of angiotensin receptor blockers in persons with type 2 diabetes and overt nephropathy for preservation of kidney function. Among persons with type I diabetes with or without overt nephropathy, type 2 diabetes without overt nephropathy and in nondiabetic CKD, the available clinical data support the use of angiotensin-converting enzyme inhibitors as the RAS modulator of choice. Low therapeutic target BP levels Ͻ130/80 mmHg in persons with type 2 diabetes mellitus also appear warranted based on available data mostly for reducing the risk of nonrenal cardiovascular disease and overall mortality. Hypertension, like most cardiovascular conditions, is a nutritional-hygienic disease. The seeds of hypertension are rooted in physical inactivity, obesity, high caloric intake, and excessive dietary sodium intake as well as alcohol consumption. Genetic susceptibility to hypertension remains ill-defined; however, environmental exposures of gene-environment interactions can be favorably influenced by manipulation of lifestyle choices.Prevention of hypertension-related complications such as reduced kidney function depends on population-wide control of known hypertension risk factors. Population-based hypertension pr...

Activation of the Renin-Angiotensin System and Chronic Hypoxia of the Kidney

“…The treatment of hypertension is thus now an important component in the treatment of CKD patients, not only to prevent cardiovascular complications but also to protect the kidney (5,6). Meta-regression analyses have indicated that BP reduction accounts for 50% of the variance in GFR decline and that each 10-mmHg reduction in mean arterial pressure (down to 92 mmHg) confers a benefit in GFR preservation of 3.7-5.0 mL/min per year (7)(8)(9)(10).…”

Arterial Stiffening as a Possible Risk Factor for Both Atherosclerosis and Diastolic Heart Failure

“…Atherosclerotic cardiovascular events and heart failure are major determinants of the prognosis of hypertension (2). Several studies have demonstrated that PWV relates to ultrasonographically detected atherosclerotic change in the carotid artery, which is an established marker of atherosclerosis (3,4).…”

Molecular Mechanisms of Nephro-Protective Action of HE-86 Liquid Extract in Experimental Chronic Renal Failure

“…Recent studies have shown that hypertensive nephropathy is a major leading cause of end-stage renal disease and the renin-angiotensin system plays a pivotal role in the development of progressive renal injury [34][35]. Clinical trials have shown that blocking the effects of angiotensin II (Ang II) with angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers can prevent or slow the progression of kidney damage in patients with diabetes and hypertension [34][35][36].…”