Which antihypertensive drugs are the most nephroprotective and why?
BACKGROUND
Hypertension is a major independent risk factor for kidney disease and for faster renal function loss. Choice of antihypertensive strategies with highest nephroprotective effect is crucial to prevent or reverse progression to end stage renal disease (ESRD).


METHODS
The present review focuses on the role of hypertension in the progression of chronic kidney disease (CKD), the renoprotective effects of different antihypertensive therapies, and the blood pressure levels that should be targeted in different patient populations. To this end, the PubMed (1975 - 2010) database was searched for English-language articles, using the following keywords: hypertension, kidney disease, ACE-inhibitor, angiotensin receptor blocker, aldosterone antagonist, renin inhibitor, proteinuria.


RESULTS
A comprehensive review of data on the association between hypertension and progression of chronic nephropathies and on the antihypertensive treatments with highest nephroprotective effects.


CONCLUSIONS
Blood pressure should be targeted to 140/90 mmHg or less in patients with hypertension but no renal injury and 130/80 mmHg or less in those with CKD. Amongst different antihypertensive drugs, renin angiotensin aldosterone system (RAAS) inhibitors have an incremental nephroprotective effect in proteinuric patients. Maximal RAAS inhibition should be aimed to optimize renoprotection in hypertensive patients with CKD and proteinuria.
Mario Negri Institute of Pharmacological Research, Parco Scientifico Tecnologico Kilometro Rosso, Department of Medicine and Transplantation, Via Stezzano, 87, Ospedali Riuniti, 24126 Bergamo, Italy. gremuzzi@marionegri.it
Paolo
P
Cravedi
Piero
P
Ruggenenti
Giuseppe
G
Remuzzi
D000818:Animals; D000959:Antihypertensive Agents / Q000494:pharmacology* / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects; D018450:Disease Progression; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007674:Kidney Diseases / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000517:prevention & control; D011507:Proteinuria / Q000209:etiology / Q000517:prevention & control; D012084:Renin-Angiotensin System / Q000187:drug effects; D012307:Risk Factors
D000959:Antihypertensive Agents