RENAL DYSFUNCTION COMPLICATING THE TREATMENT OF HYPERTENSION
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06.07.2009, 11:44
TREATMENT of hypertension in patients with normal renal function does not generally cause renal dysfunction. By contrast, in patients with hypertension and chronic renal insufficiency, it is not uncommon for the serum creatinine concentration to rise as the blood pressure is lowered. This complication is likely to be encountered more often since the guidelines governing adequate blood-pressure control have been made more stringent. 1,2 For many physicians, the initial response to a deterioration in renal function is to decrease the dose of antihypertensive medications. This approach is based on the belief that the kidney has been affected by an adverse event related to aggressive lowering of the blood pressure. As the blood pressure increases, the physician is reassured because the serum creatinine concentration returns to the original base line. Unfortunately, such an approach is not optimal for the long-term preservation of renal function and should be discouraged. Rather, a small, nonprogressive increase in the serum creatinine concentration occurring in the context of better bloodpressure control should be viewed as indicating that the intraglomerular pressure has been successfully reduced. Allowing blood-pressure control to deteriorate in order to prevent a rise in the creatinine concentration can harm the very patients who benefit most from tight blood-pressure control, which has been proved to slow the progression of chronic renal failure. This decline in renal function is hemodynamic in origin and not secondary to structural injury to the kidney. The decline can be traced to changes in renal autoregulation that accompany chronic renal disease.
