[Hypertension and renal insufficiency].
Hypertension is almost an inevitable complication of chronic renal failure and it contributes to the acceleration of its progression to terminal renal failure. Cohort studies and large scale clinical trials carried out in the last 10 years have allowed quantification of the respective influences and interactions of hypertension, proteinuria, and metabolic factors on the rate of degradation of renal function. They have conclusively showed a benefit in normalising the blood pressure in diabetic and nondiabetic renal disease especially when the proteinuria is pronounced and when the treatment includes an angiotensin converting enzyme inhibitor. Hypertension is also an increasingly common cause of renal failure, which may become terminal by its consequences associating vascular and ischaemic lesions of the renal parenchyma. Depending on the country studied, 10 to 25% of new dialysis patients are now classified as hypertensive and vascular renal disease. The individual renal risk of essential hypertension is relatively low except in certain groups, such as the coloured population, especially in the USA. The risk of a significant increase in creatinine is doubled by any increase of 20 mmHg of diastolic blood pressure but long-term studies suggest that the effects of increased systolic blood pressure may be even greater.
Laville
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Service de néphrologie et hypertension artérielle, pavillon P, hôpital Edouard-Herriot, 69437 Lyon.
D001794:Blood Pressure; D002986:Clinical Trials as Topic; D015331:Cohort Studies; D048909:Diabetes Complications; D006801:Humans; D006977:Hypertension, Renal / Q000150:complications* / Q000503:physiopathology; D051437:Renal Insufficiency / Q000150:complications*; D018570:Risk Assessment