Role of Hypertension on the Progression of Renal Disease in Man

Abstract

The effects of hypertension on the course of early chronic renal failure were evaluated in 233 patients with renal disease of diverse etiology, followed for 12–166 months (mean 51.35) on protein-restricted diet. On entry, 174 patients (74.6%) were hypertensive and 59 (25.4%) were normotensive. Serum creatinine levels rose from 2.40 ± 1.11 to 4.84 ± 3.26 mg/dl in the overall population. Deterioration of renal function was more evident in hypertensives (percent increase in serum creatinine 112.8, monthly increase 0.053 mg/dl) than in normotensives (percent increase 70.9, monthly increase 0.032 mg/dl). This difference, however, was not statistically significant.Progression of renal failure was significantly faster in hypertensive than in normotensive patients in the groups of polycystic kidney disease and chronic renal failure of unknown etiology. The actuarial renal survival probability at 72 months was 77% in normotensives and 47% in hypertensives. Among the 84 patients (36.1%) who had a fast deterioration of renal failure, 71 (84.5%) were hypertensive.In conclusion, hypertension seems to play an important role in worsening the prognosis of patients with renal parenchymal disease and early chronic renal failure. It is still difficult to separate the exact role of hypertension from the constellation of pathogenetic factors (such as the underlying renal disease, the magnitude and duration of proteinuria, the inadequate dietary contents of protein and phosphate) which may affect the progression of chronic renal disease in man.

Association of renal function with clinical parameters and conditions in a longitudinal population-based epidemiological study

“…Therefore, strict control of BP is highly recommended for CKD subjects and is expected to delay renal injury progression. The current results of eGFR correlating significantly and negatively with the prevalence of hypertension in the low eGFR group are consistent with the results of previous studies (8,17,18), although the exact underlying mechanisms were not evaluated.…”

“…Hypertension is a frequent complication in patients with renal impairment, and is present concurrently with other factors involved in the development of diabetes and/or non-diabetic CKD progression (8,17,18). The pathophysiology and mechanisms of hypertension in renal impairment are complex.…”

“…Impairment of autoregulation of glomerular pressure may also lead to glomerular hypertension (20). Given that activation of the renin-angiotensin-aldosterone system not only causes a rise in BP, but also promotes cell proliferation, inflammation, and matrix accumulation, it may also lead to the progression of CKD (17). Therefore, strict control of BP is highly recommended for CKD subjects and is expected to delay renal injury progression.…”

Early renal structure alteration in rat offspring from dams fed low protein diet

“…Data from 21-day-old offspring could be compared to the number found in young adult animals since no new glomeruli are normally formed after weaning. The primary consequence of low nephron number in adulthood is the increased susceptibility to renal disease progression and hypertension (Brenner et al, 1988;Maschio et al, 2000;Moritz et al, 2003). The exact mechanism of nephron number reduction due to maternal protein restriction is unclear; however, increased apoptosis in the developing kidney has been suggested (Welham et al, 2002).…”

Prospective Study of Moderate Alcohol Consumption and Risk of Hypertension in Young Women

“…[1][2][3] Persuasive epidemiologic evidence suggests that heavy alcohol consumption is strongly associated with increased risk of hypertension, 4 and approximately 3% to 8% of high blood pressure in women is attributable to alcohol consumption. 5 Activation of the sympathetic nervous system and alteration of vascular tone have been hypothesized as the probable mechanisms involved to explain this relationship.…”