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(Hypertension. 2009;54:25.)
© 2009 American Heart Association, Inc.

Editorial Commentaries

The Kidney

Both Culprit and Victim

Eberhard Ritz

From the Ruperto Carola University Heidelberg, Division Nephrology, Nierenzentrum, Im Neuenheimer Feld 162, D 69100 Heidelberg, Germany. E-mail prof.e.ritz@t-online.de

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Today, it is universally acknowledged that, in hypertension, the kidney is both culprit and victim.¹ Kidney malfunction causes hypertension, and hypertension, in turn, aggravates chronic kidney disease (CKD) and accelerates its progression. High blood pressure (frank hypertension and blood pressure values in the high normal range) are clearly correlated to progressive kidney injury, both in experimental² and in clinical³ observations.

All of the current guidelines^4,5 recommend lowering of systolic blood pressure to 130 or 125 mm Hg in CKD, and even lower values are recommended if the target level of proteinuria of <1 g per 24 hours has not been achieved.⁴ There is good evidence of "renoprotection" by lowering blood pressure in patients with renal disease, at least in the presence of proteinuria.³ In CKD patients without proteinuria, eg, autosomal polycystic kidney disease, further renoprotection cannot be achieved by lowering blood pressure below the target blood pressure recommended in patients without CKD⁶; nevertheless, these patients have a markedly elevated cardiovascular risk, and more stringent lowering of blood pressure is desirable, because, eg, reduction of left ventricular hypertrophy as an index of cardiovascular risk had been documented in such patients.⁶

The worldwide problem of neglect of hypertension and of insufficient implementation of antihypertensive treatment in CKD patients prompted the International Society of Nephrology and the International Federation of Kidney Foundations to devote this year’s World Kidney Day (http://www.worldkidneyday.org) on March 12th to the issue of hypertension.⁷

Disappointingly, the assessment of blood pressure in patients with CKD almost uniformly shows a . . . [Full Text of this Article]

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Blood Pressure Control Among Persons Without and With Chronic Kidney Disease: US Trends and Risk Factors 1999–2006

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Hypertension 2009 54: 47-56. [Abstract] [Full Text] [PDF]