[Treating high blood pressure in kidney patients: evidence and implications].
The main aim delaying progression of chronic kidney disease (CKD) are tight control of blood pressure to levels below 130/80 mmHg and reductioner 24-h urine protein to <0.5 g or microalbuminuria to <300 mg/g. First-line agents for renoprotection are angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers at the highest tolerated dose. The combination of these types of drugs, the so-called dual blockade, further reduces an elevated urinary albumin or protein excretion but, at least in patients at high cardiovascular risk, does not delay progression of renal failure. An intensified multifactorial intervention is necessary for renal patients because 35 to 50% of cases with grade 3 or 4 CKD are prone to premature complications such as end-stage renal disease and/or cardiovascular events. New strategies to block the renin-angiotensin system could be of help in improving of outcomes in CKD patients.
Marín
R
R
Servicio de Nefrología, Unidad de Hipertensión, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain. rmarini@hca.es
Gorostidi
M
M
Alvarez-Navascués
R
R
García-Melendreras
S
S
D005544:Forecasting; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D051436:Renal Insufficiency, Chronic / Q000150:complications*