Hypertension in autosomal dominant polycystic kidney disease: observational study in 207 patients with a mean follow-up of 107 months.
OBJECTIVE
Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common hereditary diseases in adults. ADPKD is a frequent cause of 4 secondary hypertension and, conversely, hypertension is a common manifestation of ADPKD and, more importantly, one of the few that are treatable. Given the autosomal dominant nature of the disease and the fact that it is easy to diagnose with a renal scan, ADPKD patients can be diagnosed early at a pre-symptomatic stage, and hypertension can be detected and treated. The main purpose of this article is to report our experience in the long-term follow-up of patients with ADPKD, with particular emphasis on hypertension.


METHODS
A retrospective analysis was made of 532 patients observed in our outpatient clinic due to renal cysts over the last 17 years, of whom 383 were diagnosed with ADPKD according to Ravine's criteria. Patients were followed-up as outpatients on a yearly basis, or more frequently if necessary. Data on demography and clinical findings were analyzed with particular emphasis on blood pressure control, number and type of antihypertensive drugs, and left ventricular mass index (LVMI).


RESULTS
At the beginning of follow-up 56% of the patients, including 30.7% of the young adults aged 20 to 34 years, were hypertensive. Focusing on 207 patients observed in 2006, with a mean follow-up of 107 +/- 66 months, a significant decrease in systolic and diastolic blood pressure was observed between the first and last observations. Of a subgroup of 115 patients who were normotensive at the initial observation, 50% became hypertensive by the age of 40. During follow-up, only eleven had a cardiovascular event such as angina, myocardial infarction, stroke or peripheral artery disease (rate 0.006 events/patient-year). LVMI correlated with age, renal function and systolic and diastolic blood pressure, but only age was an independent risk factor for increased left ventricular mass.


CONCLUSIONS
Hypertension is a common complication in ADPKD patients. Early diagnosis and follow-up at a pre-symptomatic stage of the disease are important since this enables early initiation of antihypertensive therapy, which could reduce the rate of cardiovascular events in this population.
De Almeida
Edgar A F
EA
Serviço de Nefrologia e Transplantação Renal, Hospital de Santa Maria, Lisboa, Portugal.
Prata
M Martins
MM
D000328:Adult; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D016891:Polycystic Kidney, Autosomal Dominant / Q000150:complications*; D012189:Retrospective Studies; D013997:Time Factors