[Arterial hypertension and cardiovascular risk in patients with nephropathy].
In the general population, there is a very close link between arterial hypertension and cardiovascular diseases (CVDs); hypertension is the most important predictive factor for coronary disease. In the patient with renal insufficiency, along with the classical factors behind vascular damage, there are those linked to uremia such as oxidative stress, hyperhomocysteinemia, ADMA and chronic microinflammation, responsible for the process of early atherosclerosis. Nevertheless, many questions remain unanswered concerning the optimum pressure target, both in terms of which arterial pressure could be more indicative of organ damage and the ideal pressure range for the patient. On the one hand, recent studies in populations with advanced renal insufficiency have cast doubts on the close relationship between hypertension and cardiovascular mortality, attributing a more unfavorable prognostic weight to hypotension than to hypertension. On the other hand, a new concept concerning arterial pressure has been developing over recent years, i.e. differential pressure, which is supposed to represent a vascular damage index, in terms of wall rigidity; and therefore, arterial compliance, which is more reliable, complete and dynamic as compared to the traditional pressure markers such as systolic, diastolic and mean blood pressure (BP). This renders our attempt to control the risk factors as somewhat limited, with the sole control of systolic BP and diastolic BP in absolute terms. Control that to judge from the various studies published to date, appears to be far from easy to implement in clinical practice, and above all in dialysis.
Santoro
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U.O. Nefrologia-Malpighi, Policlinico S.Orsola-Malpighi, Bologna -Italy. Santoro@orsola-malpighi.med.unibo.it
Bainotti
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D002318:Cardiovascular Diseases / Q000209:etiology*; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000150:complications*; D012307:Risk Factors