Cardiovascular risk in hypertensive patients with renal dysfunction

被引：1
作者：
Ravera M. [1 ]
Re M. [1 ]
Weiss U. [1 ]
Cannavo R. [1 ]
Deferrari L. [1 ]
Deferrari G. [1 ,2 ]
机构：
[1] Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa, Genoa
[2] Department of Internal Medicine, Division of Nephrology, Dialysis and Transplantation, University of Genoa, 616123 Genoa, Viale Benedetto XV
来源：
High Blood Pressure & Cardiovascular Prevention | 2009年 / 16卷 / 1期
关键词：
Albuminuria; Cardiovascular risk; Chronic kidney disease; Hypertension; Renin-angiotensin aldosterone system (RAAS) blockade;
D O I：
10.2165/00151642-200916010-00003
中图分类号：
学科分类号：
摘要：
Chronic kidney disease (CKD) is associated with elevated cardiovascular morbidity and mortality. Cardiovascular disease (CVD) is highly prevalent in CKD and mortality due to CVD is 5- to 200-fold higher in dialysis patients than in the general population.The increase in CVD burden in patients with CKD is due to both the development of new risk factors that are specifically related to kidney disease, and the increase in the expression of conventional risk factors. Arterial hypertension plays a major role in this setting. Indeed, a strong association exists of hypertension with renal damage. Hypertension is one of the most frequent conditions leading to CKD. Furthermore, it is highly prevalent in all the stages of CKD and it is associated with increased cardiovascular risk.This review focuses on the epidemiology of CKD in hypertensive patients and will comment on renal dysfunction as a novel risk marker for CVD. Therapeutic strategies for cardiovascular prevention in CKD patients will also be discussed.The presence of renal dysfunction, whether manifested by albuminuria, reduction in glomerular filtration rate or both, is a strong predictor of major cardiovascular events in hypertensive patients.Recent guidelines for the management of hypertension recommend taking account of renal dysfunction when stratifing cardiovascular risk profile. When either increased albuminuria or reduced glomerular filtration rate is present, high added risk indeed exists in hypertensive patients for any given level of blood pressure. Moreover, according to the National Kidney Foundation-KidneyDisease Outcomes Quality Initiative (NFK-KDOQI), patients with CKD must be considered in the 'highest risk group' for subsequent cardiovascular events. Thus, therapeutic strategies for cardiovascular prevention that are based on risk stratification should take into account that patients with renal dysfunction are in the 'highest risk' condition.Effective cardioprotective treatment should include optimal blood pressure control, aimed at achieving blood pressure values lower than 13080mmHg and the adoption of renin-angiotensin aldosterone system- blocking agents. Furthermore, recent clinical evidence indicates that a change in urinary albuminprotein excretion is a reliable index of response to antihypertensive treatment and a strong predictor of both renal and cardiovascular outcomes. What is even more intriguing is that this effect appears to be independent of modifications in either blood pressure or other risk factors. Finally, a multifactorial approach is highly recommended when dealing with hypertensive patients with renal dysfunction, in order to improve their cardiovascular prognosis. © 2009 Adis Data Information BV.
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页码：13 / 20
页数：7
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