This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pettinger, W. A. Articles by Mitchell, H. C. Search for Related Content PubMed PubMed Citation Articles by Pettinger, W. A. Articles by Mitchell, H. C.

Hypertension, Vol 13, 766-772, Copyright © 1989 by American Heart Association

ARTICLES

Long-term improvement in renal function after short-term strict blood pressure control in hypertensive nephrosclerosis

WA Pettinger, HC Lee, J Reisch and HC Mitchell
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.

Seventy-nine hypertensive nephrosclerosis patients entered a prospective randomized single-blind study to 1) establish the pattern of decay of renal function in this population and the variability therein and 2) to determine if strict diastolic blood pressure (DBP) control (less than or equal to 80 mm Hg) is more effective than conventional levels (90-95 mm Hg) in conserving renal function. Because of unexpected significant improvement in renal function in patients from both groups, which changed the perspectives on the course of this disease as described herein, this report is being published before completion of the trial. The selection criteria were 1) serum creatinine concentration of 1.6-7.0 mg/dl, 2) glomerular filtration rate of less than 70 ml/min/1.73 m2, and 3) absence of diseases (other than hypertension) known to destroy renal function. Renal function was assessed by glomerular filtration rate [( 125I]iothalamate clearance) and serum creatinine concentration. Before randomization, DBP was aggressively treated to reduce it to less than 80 mm Hg. Twenty-two subjects (14 in the strict DBP control group and eight in the conventional DBP control group) have been enrolled in the study for 36 months. In contrast to results from previous studies in humans and rats, renal function improved in both patient groups. Thus, irrevocable progression of renal damage after onset of renal failure from high blood pressure does not necessarily occur, and in fact, long-term improvement of renal function resulted from the effects of the study itself.(ABSTRACT TRUNCATED AT 250 WORDS)

This article has been cited by other articles:

				A. Shankar, R. Klein, B. E.K. Klein, F. J. Nieto, and S. E. Moss Relationship Between Low-Normal Blood Pressure and Kidney Disease in Type 1 Diabetes Hypertension, January 1, 2007; 49(1): 48 - 54. [Abstract] [Full Text] [PDF]

				J. A. Jaffe and P. L. Kimmel Chronic Nephropathies of Cocaine and Heroin Abuse: A Critical Review Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 655 - 667. [Abstract] [Full Text] [PDF]

				M. A. Moore, M. Epstein, L. Agodoa, and L. D. Dworkin Current Strategies for Management of Hypertensive Renal Disease Arch Intern Med, January 11, 1999; 159(1): 23 - 28. [Abstract] [Full Text] [PDF]

				National High Blood Pressure Education Program Wor 1995 Update of the Working Group Reports on Chronic Renal Failure and Renovascular Hypertension Arch Intern Med, September 23, 1996; 156(17): 1938 - 1947. [Abstract] [PDF]

				M. J. Klag, P. K. Whelton, B. L. Randall, J. D. Neaton, F. L. Brancati, C. E. Ford, N. B. Shulman, and J. Stamler Blood Pressure and End-Stage Renal Disease in Men N. Engl. J. Med., January 4, 1996; 334(1): 13 - 18. [Abstract] [Full Text] [PDF]

				N. K. Hollenberg and L. Raij Angiotensin-Converting Enzyme Inhibition and Renal Protection: An Assessment of Implications for Therapy Arch Intern Med, November 8, 1993; 153(21): 2426 - 2435. [Abstract] [PDF]

				G. D. Johnston, W. A. Pettinger, H.-C. Lee, B. Z. Paulshock, B. J. Materson, D. J. Reda, W. C. Cushman, and C. F. Rouse Single-Drug Therapy for Hypertension in Men N. Engl. J. Med., September 30, 1993; 329(14): 1043 - 1045. [Full Text]

				T. V. Perneger, F. J. Nieto, P. K. Whelton, M. J. Klag, G. W. Comstock, and M. Szklo A Prospective Study of Blood Pressure and Serum Creatinine: Results From the 'Clue' Study and the ARIC Study JAMA, January 27, 1993; 269(4): 488 - 493. [Abstract] [PDF]

				R. L. Koretz Studies within Studies Ann Intern Med, April 15, 1992; 116(8): 698 - 698. [Abstract] [PDF]

				R. D. Toto, H. C. Mitchell, H.-C. Lee, C. Milam, and W. A. Pettinger Reversible Renal Insufficiency due to Angiotensin Converting Enzyme Inhibitors in Hypertensive Nephrosclerosis Ann Intern Med, October 1, 1991; 115(7): 513 - 519. [Abstract] [PDF]

				National High Blood Pressure Education Program National High Blood Pressure Education Program Working Group Report on Hypertension and Chronic Renal Failure Arch Intern Med, July 1, 1991; 151(7): 1280 - 1287. [Abstract] [PDF]

				S. J. Rosansky, D. R. Hoover, L. King, and J. Gibson The Association of Blood Pressure Levels and Change in Renal Function in Hypertensive and Nonhypertensive Subjects Arch Intern Med, October 1, 1990; 150(10): 2073 - 2076. [Abstract] [PDF]