The kidney and cardiovascular risk--implications for management: a consensus statement from the European Society of Hypertension.
Cardiovascular and renal diseases share many of the same risk factors. In fact, renal failure is usually accompanied by an increased global cardiovascular risk. Thus, preservation of kidney function might simultaneously protect the heart and the brain and, conversely, addressing cardiovascular risk factors might safeguard the kidney. This review considers the evidence supporting this approach, focusing on the protective effect of blood-pressure lowering and the ancillary actions of antihypertensive agents on renal protection. We review recent evidence on renal protection in individuals with and without diabetes, and the importance of offering a high standard of care also to those with the metabolic syndrome or prediabetes in order to prevent initial forms of renal, and as a consequence, cardiovascular damage. Intervention may be appropriate even in individuals with high-normal blood pressure, if they already have early renal and/or cardiovascular risk markers. As a consequence of these insights, thresholds for starting antihypertensive therapy are gradually falling, whereas awareness of the need for an early intervention in patients at high risk of developing renal damage and simultaneously cardiovascular disease is growing.
Ruilope
Luis
L
Hypertension Unit, Hospital 12 de Octubre, Madrid, Spain. ruilope@ad-hocbox.com
Kjeldsen
Sverre E
SE
de la Sierra
Alejandro
A
Mancia
Giuseppe
G
Ruggenenti
Piero
P
Stergiou
George S
GS
Bakris
George L
GL
Giles
Thomas D
TD
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002908:Chronic Disease; D048909:Diabetes Complications / Q000517:prevention & control; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control*; D024821:Metabolic Syndrome / Q000150:complications; D012307:Risk Factors
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors