Role of hypertension on the progression of renal disease in man.

Abstract

The effects of hypertension on the course of early chronic renal failure were evaluated in 233 patients with renal disease of diverse etiology, followed for 12-166 months (mean 51.35) on protein-restricted diet. On entry, 174 patients (74.6%) were hypertensive and 59 (25.4%) were normotensive. Serum creatinine levels rose from 2.40 +/- 1.11 to 4.84 +/- 3.26 mg/dl in the overall population. Deterioration of renal function was more evident in hypertensives (percent increase in serum creatinine 112.8, monthly increase 0.053 mg/dl) than in normotensives (percent increase 70.9, monthly increase 0.032 mg/dl). This difference, however, was not statistically significant. Progression of renal failure was significantly faster in hypertensive than in normotensive patients in the groups of polycystic kidney disease and chronic renal failure of unknown etiology. The actuarial renal survival probability at 72 months was 77% in normotensives and 47% in hypertensives. Among the 84 patients (36.1%) who had a fast deterioration of renal failure, 71 (84.5%) were hypertensive. In conclusion, hypertension seems to play an important role in worsening the prognosis of patients with renal parenchymal disease and early chronic renal failure. It is still difficult to separate the exact role of hypertension from the constellation of pathogenetic factors (such as the underlying renal disease, the magnitude and duration of proteinuria, the inadequate dietary contents of protein and phosphate) which may affect the progression of chronic renal disease in man.