Important advances in our understanding of the mechanisms and treatment of hypertension in patients at risk for renal disease and those with overt renal disease are taking place. Thus, new data suggest that hyperfiltration may be an important antecedent to the development of kidney disease in hypertensive African-Americans. Also new studies provide evidence for differential responses of endothelial function and sympathetic nerve traffic to ACE inhibitors versus dihydropyridine calcium channel blockers in hypertensives with and without overt renal disease. Important new studies also show that in proteinuric subjects ACE inhibitor treatment is superior to non-ACE treatment at reducing proteinuria add the risk of developing ESRD in non-diabetics with renal disease. In hemodialysis patients, both systolic hypertension and hypotension predict increased mortality in hemodialysis patients. And, identification of factors important in persisting hypertension in patients on hemodialysis provide new insights into improving BP control in this population. The purpose of this review is to highlight the key elements and clinical relevance of these recent studies.
- Angiotensin II receptor antagonists
- Angiotensin-converting enzyme inhibitors
- Sympathetic nervous system
ASJC Scopus subject areas