Renal function: the Cinderella of cardiovascular risk profile.
The presence of an altered renal function in essential hypertension, advanced heart failure (HF) and after a myocardial infarction (MI) is associated with higher cardiovascular morbidity and mortality. Indices of altered renal function (e.g., microalbuminuria, increased serum creatinine concentrations, decrease in estimated creatinine clearance or overt proteinuria) are independent predictors of cardiovascular morbidity and mortality in any of the three clinical situations. These parameters should then be routinely evaluated in clinical practice. These facts have several therapeutic implications. First, although there is no evidence-based information on the level of blood pressure that confers optimal renal protection, levels substantially lower than past recommendations are advisable. Second, hypertensive kidney damage should be prevented by early treatment of hypertensive patients, particularly those with microalbuminuria. Finally, to avoid further aggravation of high cardiovascular risk, antihypertensive agents devoid of unwanted metabolic side effects should be used for the treatment of hypertensive vascular damage. In HF, the combination of an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker seem to be the most renoprotective. Renal outcome is also improved by ACE inhibition after an MI. Finally, renal and cardiovascular outcome seem to run in parallel in all these situations.
Ruilope
L M
LM
Unidad de Hipertensión, Hospital 12 de Octubre, Madrid, Spain. Luis_M_Ruilope@teleline.es
van Veldhuisen
D J
DJ
Ritz
E
E
Luscher
T F
TF
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002423:Cause of Death; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000401:mortality*; D007677:Kidney Function Tests; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality*; D051437:Renal Insufficiency / Q000188:drug therapy / Q000401:mortality*; D012307:Risk Factors
D000806:Angiotensin-Converting Enzyme Inhibitors