Which Comes First—Renal Dysfunction or High Blood Pressure?

Hsu, CY; McCulloch, C.E.; Darbinian, Jeanne; Go, AS; Iribarren, Carlos

doi:10.1681/asn.2005080814

Journal of the American Society of Nephrology

2005

DOI: 10.1681/asn.2005080814

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Which Comes First—Renal Dysfunction or High Blood Pressure?

CY Hsu¹,

C.E. McCulloch²,

Jeanne Darbinian³

et al.

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Cited by 10 publications

References 77 publications

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Thinking Beyond New Clinical Guidelines: Update in Hypertension

Griffin

Schinstock

2015

Mayo Clinic Proceedings

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Hypertension is one of the most common conditions managed by generalists and is a major risk factor for multiple conditions. Surrounded by great debate, the committee appointed to the Eighth Joint National Committee published their suggestions for new hypertension treatment guidelines in early 2014. We suggest a new target blood pressure (BP) for the general population older than 60 years of less than 150/90 mm Hg, up from less than 140/90 mm Hg as recommended by the Seventh Joint National Committee, and in diabetic patients, a goal of less than 140/90 mm Hg, up from the Seventh Joint National Committee recommendation of less than 130/80 mm Hg. Regardless of the BP target recommendations suggested by the Eighth Joint National Committee and other organizations, obtaining accurate BP readings and recognizing white-coat and masked hypertension is imperative. Home and ambulatory BP monitoring are useful tools in addition to proper in-office BP readings. The optimal care of the hypertensive patient involves accurate BP characterization, careful use of guidelines, and good clinical judgment.

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Thinking Beyond New Clinical Guidelines: Update in Hypertension

Griffin

Schinstock

2015

Mayo Clinic Proceedings

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Does the Hyperfiltration of Minoxidil Result in Increased Proteinuria and Loss of Renoprotection Conferred by Angiotensin Inhibition?

Diskin

Stokes²,

Dansby³

et al. 2006

Kidney Blood Press Res

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The objective of the present study was to retrospectively examine whether the addition of minoxidil to patients who were already treated with maximum doses of angiotensin-converting enzyme inhibitors and angiotensin receptor blockers but who had not achieved target blood pressures, has any detrimental effect on proteinuria or renal function or whether its effect on blood pressure prove salutary. The clinical records of the patients seen at the Hypertension, Nephrology, Dialysis and Transplantation Clinic from June 1982 through May 2005 were reviewed to identify 54 patients (78% men, 82% African-American) who had taken minoxidil (with and without angiotensin inhibition and blockade) and who had documented 24-hour urines for creatinine clearance and quantification of proteinuria before the initiation of minoxidil and after the blood pressure had stabilized on its final dose. The study was done at the Hypertension, Nephrology, Dialysis and Transplantation Clinic, the regional referral center for renal problems in eastern Alabama, USA. Minoxidil, whether alone or in combination with maximum doses of ACEIs and ARBs, was very successful in reduction of mean arterial pressure, but there was a tendency towards an increase in proteinuria. When minoxidil was given alone, patients demonstrated a trend towards reduction of proteinuria associated with blood pressure reduction; however, when minoxidil was added after the maximal doses of ACEIs and ARBs had been reached there was a significant increase in proteinuria (p = 0.017) on paired comparison in the same patients whose proteinuria had already demonstrated a significant decrease (p = 0.02) on the ACEI and ARB alone despite further significant reduction of blood pressure with the minoxidil (p = 0.003). Renal function deterioration to end stage renal disease correlated with increase in proteinuria (p = 0.03). We conclude that minoxidil was very effective in lowering systemic blood pressure but when given to patients already on maximum doses of ACEI and ARBs, there was an increase in proteinuria which could be interpreted as a detrimental effect having in mind that the blood pressure was significantly lowered.

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Prehypertensive African-American Women Have Preserved Nitric Oxide and Renal Function but High Cardiovascular Risk

Feairheller

Diaz

Veerabhadrappa

et al. 2010

Kidney Blood Press Res

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Aims: African-Americans, in particular women, exhibit disproportionate levels of hypertension, inflammation, and oxidative stress compared to other ethnic groups. The relationship between prehypertension, renal function, inflammation, and oxidative stress was examined. Methods: Twenty-eight African-American women (53.5 ± 1.1 years) followed an AHA diet and then underwent 24-hour ambulatory BP (ABP) monitoring. Urinary albumin (uAlb), serum and urinary creatinine, glomerular filtration rate (GFR), 24-hour urinary Na⁺ excretion, plasma superoxide dismutase, total antioxidant capacity (TAC), urinary (uNOx) and plasma (pNOx) nitric oxide levels, and high-sensitivity C-reactive protein (hsCRP) were measured. Results: When the group was divided by average 24-hour ABP into optimal and nonoptimal groups, a significant difference existed between the groups for uNOx (p = 0.001; nonoptimal: 933.5 ± 140.4, optimal: 425.0 ± 52.6 µmol/gCr), and for hsCRP (p = 0.018, nonoptimal: 3.9 ± 0.7, optimal: 1.9 ± 0.6 mg/l). Significant inverse relationships existed between hsCRP and uNOx and between uAlb and pNOx in the non-optimal group, between GFR and pNOx in the entire group, and positive association existed between TAC and uNOx in the optimal group. Conclusions: These results suggest that in African-American women as BP levels rise toward hypertension, the NO/NOS balance may be associated with renal function, and may have implications for CV risk based on their hsCRP levels.

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Which Comes First—Renal Dysfunction or High Blood Pressure?

Cited by 10 publications

References 77 publications

Thinking Beyond New Clinical Guidelines: Update in Hypertension

Thinking Beyond New Clinical Guidelines: Update in Hypertension

Does the Hyperfiltration of Minoxidil Result in Increased Proteinuria and Loss of Renoprotection Conferred by Angiotensin Inhibition?

Prehypertensive African-American Women Have Preserved Nitric Oxide and Renal Function but High Cardiovascular Risk

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