Showing papers by "Luis M. Ruilope published in 2004"
TL;DR: Control of BP, particularly of systolic BP, is still far from optimal in hospital-based hypertension units, and a more aggressive behavior of doctors treating uncontrolled hypertension is needed.
Abstract: Goal blood pressure (BP) was defined by the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-VI) and the World Health Organization-International Society of Hypertension (WHO/ISH) as 1 g/d. Poorer BP control was observed among patients at high risk, with diabetes, renal disease, or obesity, than in lower-risk groups. BP control was lower for systolic than for diastolic BP. In >50% of uncontrolled patients, no measures were taken by doctors to optimize pharmacologic treatment, and approximately one-third of patients were still using drug monotherapy. Control of BP, particularly of systolic BP, is still far from optimal in hospital-based hypertension units. Patients at high risk, with diabetes or proteinuria, warrant focused attention. Moreover, a more aggressive behavior of doctors treating uncontrolled hypertension is needed.
205 citations
TL;DR: Eplerenone was as effective as enalapril as monotherapy in patients with stage 1 or 2 hypertension, was more effective in reducing albuminuria, and was well tolerated for 12 months.
Abstract: This study compared the efficacy and tolerability of eplerenone and enalapril in 499 patients with stage 1 or 2 hypertension who were randomized to receive eplerenone or enalapril for 6 months in a 3-step titration-to-effect study. After 6 months, patients whose diastolic blood pressure (BP) was <90 mm Hg had their dosages down-titrated were followed for an additional 6 months. Diastolic BP was the primary end point. Eplerenone was as effective as enalapril in reducing both systolic BP (eplerenone, -14.5 mm Hg; enalapril, -12.7 mm Hg; p = 0.199) and diastolic BP (eplerenone, -11.2 mm Hg; enalapril, -11.3 mm Hg; p = 0.910) at 6 months. BP reductions at 12 months were also similar between groups (-16.5/-13.3 mm Hg for eplerenone, -14.8/-14.1 mm Hg for enalapril; p = 0.251 and 0.331, respectively). Withdrawal rates for adverse events (eplerenone 7.9%, enalapril 9.3% at 6 months) and treatment failures (eplerenone 23.3%, enalapril 22.8% at 6 months) were also equivalent. Approximately 2/3 of each group had normal BP with monotherapy treatment at 6 months. BP response was independent of renin levels in the eplerenone group, but not in the enalapril group. Both agents reduced albuminuria in patients who had an elevated value at baseline, with significantly greater improvement in patients treated with eplerenone versus enalapril (-61.5% vs -25.7%; p = 0.01). Both agents were similarly well tolerated, and there was no increased incidence of any sexual adverse events in the eplerenone group. Patients taking enalapril had a higher rate of cough. Both agents increased serum potassium levels, but <1% in each group reported adverse events from hyperkalemia. Eplerenone was as effective as enalapril as monotherapy in patients with stage 1 or 2 hypertension, was more effective in reducing albuminuria, and was well tolerated for 12 months.
159 citations
TL;DR: Analysis of the evolution of GFR, assessed as creatinine clearance, during long-term follow-up of hypertensive patients and evaluation of the impact of the development of chronic kidney disease (CKD) on cardiovascular prognosis found that in essential hypertension patients with normal renal function at baseline, theDevelopment of CKD during the follow- up is strongly and independently related with poor cardiovascular prog outlook.
Abstract: The existence of a significant percentage of treated hypertensive patients presenting a diminished renal function has been recently described. Mild renal function abnormalities are recognized as powerful predictors of cardiovascular morbidity and mortality. However, longitudinal data demonstrating this association are lacking. The objectives of this study have been analysis of the evolution of GFR, assessed as creatinine clearance (CrCl), during long-term follow-up of hypertensive patients and evaluation of the impact of the development of chronic kidney disease (CKD) on cardiovascular prognosis. A historical cohort of 281 patients attending our Hypertension Unit was selected according to the following criteria: essential hypertension, more than 5 yr of follow-up, and normal GFR at baseline (CrCl > 90 ml/min per 1.73 m(2)). Patients had an average follow-up of 13.2 +/- 4.8 yr. Forty-one patients (14.6%) developed CKD (CrCl < 60 ml/min per 1.73 m(2)) attributed to hypertensive nephrosclerosis. Initial serum creatinine, age, systolic BP at baseline, and average total cholesterol during follow-up were independent predictors of CKD development. Forty-nine (17.4%) of 281 patients presented a cardiovascular event during follow-up: 17 patients (40.6%) who developed CKD and 32 patients (13.3%) with preserved renal function (log rank test P < 0.001). After adjustment in a Cox multivariate analysis, age, development of CKD during follow-up, and male gender were independent predictors of the appearance of cardiovascular events. In essential hypertensive patients with normal renal function at baseline, the development of CKD during the follow-up is strongly and independently related with poor cardiovascular prognosis.
102 citations
TL;DR: Renal function is an important predictor of risk in hypertensive patients at high risk and antihypertensive treatment with a long-acting dihydropyridine calcium channel blocker may better preserve renal function than would treatment with diuretics.
Abstract: Background Increasing evidence suggests renal involvement in hypertension-related cardiovascular and cerebrovascular complications. To assess this role of renal function in more detail, we studied the evolution of renal function and the relationship of renal function with mortality and morbidity in the Intervention as a Goal in Hypertension Treatment (INSIGHT) study. Methods The INSIGHT study was a double-blind, randomized, multicenter trial in patients with hypertension and at least 1 additional cardiovascular risk factor. Treatment consisted of nifedipine gastrointestinal therapeutic system, 30 mg/d, or hydrochlorothiazide-amiloride (25 mg/d of hydrochlorothiazide and 2.5 mg/d of amiloride hydrochloride). Primary outcome was a composite of cardiovascular death, myocardial infarction, heart failure, and stroke. Renal function was assessed by measuring creatinine clearance, serum creatinine level, and serum uric acid level and by the presence of proteinuria. Results Creatinine clearance fell more in nifedipine recipients than in hydrochlorothiazide-amiloride recipients. Renal insufficiency developed in 2% of nifedipine recipients and 5% of hydrochlorothiazide-amiloride recipients. Primary outcomes occurred in 15% of patients with increased serum creatinine levels and 6% of patients with normal levels (odds ratio [OR] 2.89; 95% confidence interval [CI], 1.92-4.36; P P Conclusions Renal function is an important predictor of risk in hypertensive patients at high risk. Antihypertensive treatment with a long-acting dihydropyridine calcium channel blocker may better preserve renal function than would treatment with diuretics.
101 citations
TL;DR: A high incidence of ED was found in hypertensive patients from Spanish SCHUs and sildenafil showed an excellent response and safety profile.
76 citations
TL;DR: This article uses a series of case studies to demonstrate the implications of replacing the traditional "single risk factor-based" approach to managing hypertension by one based on global risk assessment, both in the clinical management of individual patients and in guidelines.
68 citations
TL;DR: Despite a shorter half-life, 160 mg/day valsartan was more effective in lowering blood pressure over 24 h than 80 mg/ day telmisartan, an observation that may have important therapeutic implications, given the mounting evidence that pulse pressure may be a risk factor for future cardiovascular events.
Abstract: ObjectivesThis trial investigated and compared the antihypertensive efficacy of telmisartan and valsartan, two angiotensin II receptor blockers, used in monotherapy at their maximum recommended dose in hypertensive patients.MethodsWe studied 70 subjects (32 men and 38 women) aged 47.6 ± 12.2 (mean ±
46 citations
TL;DR: Recent data indicate that minor derangements of renal function, including proteinuria, are associated, both in the community and in the hypertensive population, with the clustering of cardiovascular risk factors observed in metabolic syndrome that promote progression of atherosclerosis.
45 citations
TL;DR: Estimating the prevalence of diminished creatinine clearance in hypertensive patients with or without MS and investigating the factors accompanying this abnormality and factors related to the finding of a diminished CC in MS and non-MS patients were similar.
Abstract: Recent evidence highlights the relationship between metabolic syndrome (MS) and increased risk of cardiovascular (CV) diseases. Mild renal function abnormalities are associated with an enhanced CV risk, considered to be due to the presence of associated risk factors. Hence, MS and renal abnormalities could be linked and contribute to augment CV risk. For estimating the prevalence of diminished creatinine clearance (CC; <60 ml/min per 1.73 m(2)) in hypertensive patients with or without MS and for investigating the factors accompanying this abnormality, 1625 hypertensive patients, aged 18 yr or older, were included. The presence of MS was defined according to the Adult Treatment Panel III criteria. The overall prevalence of MS was 49.4% (n = 802). No significant difference was found for CC between those with and without MS, albeit the presence of MS was accompanied by greater urinary albumin excretion (P = 0.01). The prevalence of a diminished CC was also similar in the two groups. MS-positive patients presented a progressive decay in CC when classified as normoglycemic (n = 319), impaired fasting glucose (n = 237), and diabetic patients (n = 246; 85.9 +/- 30.2, 81.8 +/- 26.8, and 75.2 +/- 25.7 ml/min per 1.73 m(2), respectively; P = 0.0007 linearity test) and the opposite for microalbuminuria (29.5 +/- 45.5, 45.0 +/- 96.6, and 74.1 +/- 146.3 mg/24 h, respectively; P = 0.001 linearity test). In multiple regression analysis, factors related to the finding of a diminished CC in MS and non-MS patients were similar. Hypertensive patients at a relatively young age present with an elevated prevalence of minor abnormalities of renal function that is mostly related to the presence of metabolic alteration of glucose together with age and BP.
41 citations
TL;DR: Data are reported indicating for the first time that a decrease in urinary albumin excretion rate is accompanied by a significant decrease in cardiovascular events, providing the first evidence showing that regression of an intermediate end-point, microalbuminuria, ensures a better cardiovascular prognosis.
Abstract: Microalbuminuria has been shown to predict an increased probability of suffering a cardiovascular event or death. It has also been shown to be decreased by antihypertensive therapy and in particular by drugs counteracting the effects of angiotensin II. In this issue of Journal of Hypertension data, from the LIFE study, are reported indicating for the first time that a decrease in urinary albumin excretion rate is accompanied by a significant decrease in cardiovascular events. This evidence is of great relevance because it constitutes the first evidence showing that regression of an intermediate end-point, microalbuminuria, ensures a better cardiovascular prognosis.
24 citations
TL;DR: Large randomized, controlled trials and their metaanalyses provide the strongest evidence about several aspects of antihypertensive therapy, including left ventricular hypertrophy, intima–media thickness, renal function and new onset diabetes.
Abstract: Large randomized, controlled trials and their metaanalyses provide the strongest evidence about several aspects of antihypertensive therapy. Nonetheless, the assessment and monitoring of intermediate objectives play an important role in providing scientific evidence for delineating the best antihypertensive treatment. Additionally, they provide information about the success of therapy in an individual subject above and beyond blood pressure values. Left ventricular hypertrophy (LVH), intima–media thickness, renal function and new onset diabetes are some of the potential surrogate endpoints [1].
TL;DR: In patients with ISH, nifedipine GITS and co-amilozide had similar effects on clinical outcomes and BP lowering, lending support to international guidelines for the treatment of hypertension recommending the use of long-acting dihydropyridine calcium-channel blockers as one treatment option for patients withISH.
Abstract: Aims: This study tested the effects on cardiovascular outcomes of treatments based on nifedipine gastrointestinal therapeutic system (GITS) compared with the diuretic combination co-amilozide in a pre-specified subset of patients with isolated systolic hypertension (ISH) enrolled in the International Nifedipine GITS Study: Intervention as a Goal in Hypertension Treatment (INSIGHT) study. Major findings: Of 6321 randomized patients, 1498 (23.7%) had ISH with a baseline mean BP of 173/88 mmHg in both treatment groups. Mean BP fell by 29/10 mmHg in the nifedipine and 30/10 mmHg in the diuretic group to a mean BP of 144/78 mmHg and 143/79 mmHg, respectively, at endpoint. The percentage of primary outcomes in patients with ISH was not significantly different between the two treatment groups (nifedipine GITS 6.0%, co-amilozide 6.6%). The number of ISH patients with composite secondary outcomes was 90 (12.2%) in the nifedipine GITS group and 110 (14.5%) in the co-amilozide group (not significant). The incidence ...
TL;DR: Antihypertensive treatment is more effective than placebo for controlling SBP and DBP in previously untreated participants with type 2 diabetes exhibiting low threshold BP values.
Abstract: BACKGROUND Arterial hypertension greatly increases the risk of cardiovascular disease, renal insufficiency, and retinopathy in patients with type 2 diabetes. Epidemiological studies all document a reduced risk for the aforementioned consequences at a blood pressure (BP) lower than 130/80 mmHg. For this reason, lower target BPs are recommended by recent guidelines committees. A lower threshold BP for treatment, also proposed in guidelines, could facilitate the attainment of the recommended target BP. However, little data exist on the efficacy and safety of starting pharmacological therapy in type 2 diabetic patients exhibiting high-normal BP (HNBP) or the first stage of isolated systolic hypertension previously considered as borderline isolated systolic hypertension (BISH). OBJECTIVE To determine the antihypertensive efficacy and safety of the fixed-dose combination of the non-dihydropiridine calcium channel blocker (CCB) and ACE inhibitor verapamil SR/trandolapril 180/2 mg (V + T), versus trandolapril 2 mg (T), versus placebo (P) in previously untreated type 2 diabetic patients diagnosed as having HNBP or BISH. METHODS Multicentric, double-blind, placebo-controlled study with a 16-week follow-up in three groups totalling 438 participants. The primary end-point was to attain the recommended guideline goal of a systolic BP (SBP) value lower than 130 mmHg in all patients and a diastolic BP (DBP) value lower than 85 mmHg in HNBP. Participants were randomized (2:2:1) to verapamil V + T, T, or P. Doses were doubled at week 8 if BP was not controlled. RESULTS Both active groups were more effective than placebo to decrease SBP and DBP. The mean difference in SBP from placebo was 7.1 mmHg (3.3-10.9, 95% confidence interval (CI); P < 0.001) for T and 7.8 mmHg (3.9-11.6, 95% CI; P < 0.001) for V + T, with no statistical difference between both active groups. Combined treatment (V + T) decreased DBP by 4.6 mmHg (2.3-6.9, 95% CI; P < 0.001) more than placebo and 2.1 mmHg (0.3-4.0, 95% CI; P = 0.021) more than T. At the end of the study, 36.5% in the T group, 37.8% in the V + T group, and 14.9% (P = 0.009, P versus V + T and T) had attained the primary end-point. No significant difference was found between T and V + T with regard to the percentage of good control for SBP, but the control rate on the DBP (DBP < 85 mmHg) was significantly higher in the V + T group (88.8%), when compared with T (79.1%) or P (63.5%) (P = 0.002). Withdrawal rates due to adverse effects did not differ among trandolapril alone (9.4%), the combination (11.7%) and placebo (8.1%). CONCLUSION Antihypertensive treatment is more effective than placebo for controlling SBP and DBP in previously untreated participants with type 2 diabetes exhibiting low threshold BP values. Combination therapy with verapamil SR/trandolapril was more effective than trandolapril alone for controlling DBP.
TL;DR: It is well established among nephrologists that advanced renal failure is associated with an increased prevalence of cardiovascular (CV) disease including myocardial infarction, stroke and heart failure.
Abstract: It is well established among nephrologists that advanced renal failure is associated with an increased prevalence of cardiovascular (CV) disease including myocardial infarction, stroke and heart failure [1]. Recently, a great amount of information has become available, which demonstrates that the finding of minor abnormalities of renal function also predicts more CV risk in the general population, as well as in hypertensive patients [2]. Recently, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) have published their guidelines for the management of arterial hypertension [3]. This came only a short time after the JNC 7 report had been published [4]. Some of the relevant changes refer to the introduction of new risk factors that have come to complete the list of major CV risk factors. In this sense, both guidelines recognize the relevance of minor abnormalities of renal function, easily detectable by practicing physicians, for the stratification of patients with arterial hypertension. The Seventh Report of the Joint National Committee [4] considers the findings of microalbuminuria or diminished estimated level of glomerular filtration rate (eGFR) ( 55 years in men and 65 years in women, and a family history of premature CV disease. Similarly the ESH/ESC guidelines [3] contemplate among the factors influencing prognosis in hypertensive patients the finding of a slight elevation in serum creatinine (>1.3mg/dl in men and 1.2mg/dl in women) and/or microalbuminuria. The presence of chronic kidney disease, defined in ESH/ESC guidelines as serum creatinine values >1.5mg/dl in men and 1.4mg/dl in women or by the presence of proteinuria (>300mg/day), is also considered as a CV risk factor. The ESH/ESC guidelines also recommend to estimate either the creatinine clearance (using the Cockroft– Gault formula) or the glomerular filtration rate [eGFR—using the modified Modification of Diet in Renal Disease (MDRD) formula] [3].
TL;DR: The association between blood pressure and stroke is reviewed and data from randomized controlled trials involving diverse therapies, especially those regarding the renin-angiotensin system are analysed, to determine specific effects of drug classes on cardiovascular risk.
Abstract: PURPOSE OF REVIEW Our aim is to review the association between blood pressure and stroke and analyse data from randomized controlled trials involving diverse therapies, especially those regarding the renin-angiotensin system. In addition, an overview of stroke pathogenesis is given and its relationship with treatment action mechanisms reviewed. RECENT FINDINGS Stroke is a leading cause of death worldwide. In addition, many survivors of stroke suffer different degrees of disability. Because of the ageing of the global population, especially in regions of rapid economic growth, stroke will remain the second leading cause of death and in terms of disability it will be among the five most important causes in both developing and developed countries. High blood pressure is the most important risk factor for stroke, either ischemic or haemorrhagic, and established hypertension is the most prevalent modifiable risk factor. Data from controlled trials of blood-pressure-lowering treatment have demonstrated that treatment considerably lowers the risk of stroke within a few years of starting treatment. However, there exists controversy about the most efficient treatment regimen for primary and secondary prevention of stroke among the different blood-pressure-lowering treatments. SUMMARY Debate rages as to whether the benefits of treating high blood pressure are simply determined by the quality of blood-pressure control, or whether the choice of drug therapy adds or detracts from the expected benefits of blood-pressure reduction. The desirable future interventional comparative studies should consent to determine specific effects of drug classes on cardiovascular risk in the absence of the confounding effect of a relevant blood-pressure reduction that may counteract the potential blood-pressure-independent benefits of specific drug classes.
TL;DR: The completion of one of the most important trials undertaken to explore risk factors and anti‐hypertensive treatment, the Valsartan long‐term evaluation trial (VALUE), will certainly enhance understanding for the role of combination treatment in high‐risk patients, as well as contribute to the design of rational treatments for blood pressure control.
Abstract: Hypertension rarely occurs in isolation, and many hypertensives have additional risk factors for cardiovascular disease in addition to elevated blood pressure. Each patient's cardiovascular disease risk profile should be determined individually, and the treatment approach tailored to each case. Cardiovascular disease risk factors and high blood pressure are closely linked, suggesting that the ideal treatment should not only lower blood pressure, but also effectively lower overall risk. This is likely to require more than one drug, and one of the most effective and safe combinations is that of an angiotensin receptor blocker with a diuretic. The completion of one of the most important trials undertaken to explore risk factors and anti-hypertensive treatment, the Valsartan long-term evaluation trial (VALUE), will certainly enhance understanding for the role of combination treatment in high-risk patients, as well as contribute to the design of rational treatments for blood pressure control.
TL;DR: Results suggest that insulin may mediate uric acid underexcretion due to its tubular sodium retaining effect in essential hypertensive patients.
Abstract: We have examined whether hyperuricemia in essential hypertension may be related to an increased insulin secretion thereby enhancing the tubular reabsorption of sodium and thus uric acid. Insulin hypersecretion, as elicited by the oral glucose tolerance test (OGTT), increased a mean of 5‐fold in 12 essential hypertensive patients. Urinary uric acid to creatinine ratio significantly diminished by a mean of 62% after the OGTT. Simultaneously, urinary sodium to creatinine ratio decreased by a mean of 54%. These results suggest that insulin may mediate uric acid underexcretion due to its tubular sodium retaining effect in essential hypertensive patients.
TL;DR: The VALUE study concludes that VALUE ‘puts the concept of prognostic benefit beyond blood pressure-lowering to rest’ and deserves further comment regarding the conditions under which comparative studies of different antihypertensive monotherapies have been conducted.
Abstract: Two editorials were published in the August issue of Journal of Hypertension devoted to the Valsartan Antihypertensive Long-term Use Evaluation (VALUE) study [1,2]. Both articles conclude (and we do not disagree with them) that the results of the VALUE study come to confirm the supremacy of blood pressure control to prevent the development of cardiovascular events and death in hypertensive patients. However, Staessen and Birkenhäger [1] go further and conclude that VALUE ‘puts the concept of prognostic benefit beyond blood pressure-lowering to rest’. The conclusions of these two editorials deserve further comment regarding the conditions under which comparative studies of different antihypertensive monotherapies have been conducted.
Journal Article•
TL;DR: Determination of the presence of microalbuminuria and estimation of glomerular filtration rate are mandatory in order to ensure an adequate evaluation of global cardiovascular risk in the hypertensive patient.
Abstract: Recently published guidelines recognize the relevance of the finding of chronic kidney disease (CKD) in the stratification of risk of the hypertensive patient. Determination of the presence of microalbuminuria and estimation of glomerular filtration rate are mandatory in order to ensure an adequate evaluation of global cardiovascular (CV) risk in the hypertensive patient. Indices of altered renal function (e.g. microalbuminuria, increased serum creatinine concentrations, decrease in estimated creatinine clearance or overt proteinuria) are independent predictors of CV morbidity and mortality. Clustering of associated risk factors seems to justify the elevated CV morbidity and mortality observed in patients with essential hypertension and mild alterations of renal function. The increased prevalence of CKD in the general and in the hypertensive populations forces the recognition of its relevance and the need for an integrative therapeutic approach to fully protect simultaneously renal and CV systems.
TL;DR: The objective of this review is to demonstrate how results from the Program for Irbesartan Mortality and morbidity Evaluation studies apply to clinical practice, and to show how the benefits of irbsartan therapy can be realised at any stage of renal disease in patients with diabetes.
Abstract: Type 2 diabetes is increasing globally and is a major cause of conditions such as cardiovascular disease, retinopathy and nephropathy. The Diabetes Control and Complications Trial and the UK Prospective Diabetes Study demonstrated that the progression of renal disease could be slowed by tight glycaemic control and treating any associated hypertension with angiotensin-converting enzyme inhibition. Recent clinical trials have supported the use of angiotensin II receptor antagonists in the treatment of diabetic nephropathy, resulting in the approval of new therapeutic indications in the United States and Europe. The objective of this review is to demonstrate how results from the Program for Irbesartan Mortality and morbidity Evaluation studies apply to clinical practice, and to show how the benefits of irbesartan therapy can be realised at any stage of renal disease in patients with diabetes.
TL;DR: Data with a new aldosterone blocker, eplerenone, have confirmed the benefits of ald testosterone blockade in patients post-myocardial infarction, as well as in the regression of left ventricular hypertrophy in hypertensive patients and of microalbuminuria in Type 2 diabetic patients.
Abstract: Aldosterone can cause cardiovascular injury in animals and men. The aldosterone blocker, spironolactone, has been shown to reduce mortality in patients with congestive heart failure. The use of this drug in arterial hypertension has been limited by the high frequency of adverse effects. Recently published data with a new aldosterone blocker, eplerenone, have confirmed the benefits of aldosterone blockade in patients post-myocardial infarction, as well as in the regression of left ventricular hypertrophy in hypertensive patients and of microalbuminuria in Type 2 diabetic patients. The fact that eplerenone is much better tolerated open the possibility of this therapy in cardiovascular, as well as in renal disease.
TL;DR: Abstract P-248 Key Words: Combined Therapy, Blood Pressure Control, Essential Hypertension, combined therapy, blood pressure control, essentialhypertension.
TL;DR: The management of cardiovascular (CV) risk factors should be viewed as an integrated strategy of intervention aimed at correcting as many of the underlying causes of CV disease as possible, such as high blood pressure, cigarette smoking, dyslipidaemia and diabetes as mentioned in this paper.
Abstract: Coronary heart disease and cerebrovascular disease continue to be the leading causes of illness and death among adults from developed countries. Their prevalence is strongly related to the effects of many different risk factors, including high blood pressure, cigarette smoking, dyslipidaemia and diabetes. The management of cardiovascular (CV) risk factors should be viewed as an integrated strategy of intervention aimed at correcting as many of the underlying causes of CV disease as possible. Blocking the renin-angiotensin-aldosterone system with new, well-tolerated antihypertensive drugs, and blood pressure regulation by means of new drugs that also reduce plasma cholesterol levels or improve insulin resistance and glucose tolerance, could lead to a reduction of CV diseases.
TL;DR: The high prevalence of chronic kidney disease in the general and hypertensive populations forces the recognition of its relevance and the need for an integrated therapeutic approach simultaneously to protect the renal and cardiovascular systems fully.
Abstract: Purpose of review This review examines the relevance of the development of chronic kidney disease in long-term hypertensive patients on the cardiovascular prognosis. Recent findings Recently published guidelines recognize the relevance of the development of chronic kidney disease in the stratification of risk for the hypertensive patient. An adequate assessment of renal function, including an estimation of the glomerular filtration rate, is mandatory in order to ensure an adequate evaluation of the global cardiovascular risk in the hypertensive patient. The presence of subtle elevations in serum creatinine concentrations is a potent predictor of a poor cardiovascular prognosis. The clustering of associated risk factors seems to justify the elevated cardiovascular risk observed in patients with essential hypertension and mild renal function derangement. Summary Chronic kidney disease is associated with a significant increase in cardiovascular risk attributable to the simultaneous existence of other risk factors related to the metabolic syndrome. The high prevalence of chronic kidney disease in the general and hypertensive populations forces the recognition of its relevance and the need for an integrated therapeutic approach simultaneously to protect the renal and cardiovascular systems fully.