Hypertension and proteinuria are ri...

Hypertension and proteinuria are risk factors for faster progression of kidney disease. Pharmacologic dominion government of hypertension reduces urine protein excretion and deads progression of the disease. newly come guidelines included in the seventh report of the Joint National Committee for the Prevention, Detection, Evaluation, and Treatment of High progeny Pressure (JNC-7) recommend decreasing offspring pressure goals in patients with decreased renal function to les than 130/80 mm Hg Although lower children pressure levels might confer added protection, excessively soft blood pressure may be associated with increased cardiovascular disease risk. Jafar and associates reviewed the relationship between family pressure and urine protein excretion with kidney disease through performing a meta-analysis of data from the angiotensin-converting enzyme (ACE) Inhibition in Progressive Renal Disease (AIPRD) database. The database lists 1860 nondiabetic patients enlisted in randomized, controlled trials of the purport of ACE inhibitors on kidney disease progression.

All patients had been randomized to family pressure medication groups with or without ACE inhibitors. Five ACE inhibitors were used in the treatment arrange and both groups were treated to achieve a house pressure target of 140/90 mm Hg The primary expiration point was kidney disease progression, which was defined as a doubling in serum creatinine concentration or disclosure of kidney failure. The lowest risk for disease progression was at general systolic blood pressure levels of 110 to 129 mm Hg present urine protein excretion of les than 2000 mg by 24 hours (2 g by day) was associated with the lowest risk for disease progression. After adjustment for these variables, the risk of disease progression was lower in patients receiving ACE inhibitors.

The authors end that there is a sturdy relationship between higher systolic progeny pressure and urine protein excretion and kidney disease progression risk in nondiabetic patients receiving antihypertensive therapy, with or without ACE inhibitors. Lowest disease progression risk was noted in patients with systolic progeny pressures of 110 to 129 mm Hg although this relationship was weaker in patients with a urinary protein excretion of les than 1000 mg for 24 hours (1 g by day). Antihypertensive regimens that include ACE inhibitors appear to moderate kidney disease progression in nondiabetic patients.

In an accompanying editorial, Mulrow and Townsend agree that measurement of urine protein is essential, as well as reduction of systolic relations pressure to 110 to 130 mg Hg (using the lower number as a goal for patients with a protein excretion rate greater than 2000 mg by 24 hours). Combining ACE inhibitors with an angiotensin- receptor blocker appears to have additional clinical benefit to that of ACE inhibitor therapy alone.

Jafar TH et al. Progression of chronic kidney disease: the part of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition. Ann Intern M August 19 2003;139:244-52 and Mulrow CD Townsend RR Guiding lights for antihypertensive treatment in patients with nondiabetic chronic renal disease: proteinuria and offspring pressure levels? [Editorial] Ann Intern M August 19 2003;139:296-8

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