EFFECTS OF BLOOD-PRESSURE AND ANTIHYPERTENSIVE TREATMENT ON PROGRESSION OF ADVANCED CHRONIC-RENAL-FAILURE

The potential role of blood pressure and antihypertensive treatment on the progression of advanced chronic renal failure was analyzed in 223 adult patients (126 males) with well-defined primary chronic renal diseases (glomerulonephritis, n=73; angionephrosclerosis, n=24; interstitial nephritis, n=61; polycystic kidney disease, n=52, Alport's syndrome, n=13). Effect of average mean arterial pressure (MAP) obtained during follow-up, antihypertensive treatment (normotension, conventional antihypertensive treatment, angiotensin-converting enzyme inhibitors [ACEI]), gender, type of the nephropathy, age, body mass index, and protein intake were analyzed using a multivariate analysis of variance. Mean arterial pressure was significantly and independently correlated with duration (r = −0.40, P < 0.0001) and slope of creatinine clearance (ΔCcr; r = 0.32, P < 0.0001). Mean arterial pressure and anti hypertensive treatment could predict 25% of the variation in duration. Gender, type of the nephropathy, and MAP were able to predict 30% of the variation in ΔCcr. When analyzing results by type of nephropathy, MAP was significantly and inversely correlated with duration in glomerulonephritis (r = 0.29, P < 0.05), and positively with ΔCcr in angionephrosclerosis and interstitial nephritis (r = 0.49, P < 0.05 and r = 0.36, P < 0.01, respectively). In each type of nephropathy, conventional antihypertensive treatment and ACEI had grossly similar effects upon duration and slope except. In conclusion, blood pressure level is an important contributor to progression of chronic renal failure but its effect was more evident in angionephrosclerosis and interstitial nephritis at the extreme values of blood pressure distribution. Effects of conventional antihypertensive drugs and ACEI are similar except possibly in patients with angionephrosclerosis. © 1993, National Kidney Foundation, Inc.. All rights reserved.