The effect of treatment on the vascular deterioration associated with hypertension, with particular emphasis on renal function

Abstract

Renal clearance studies were performed in 133 patients with hypertensive vascular disease, 116 of whom were followed for a period of two to five years. In sixty-four of these patients serial renal function studies were performed. Forty-five of the sixty-four were treated and nineteen were untreated. Comparison of treated and untreated patients showed that effective reduction of the blood pressure arrested the renal vascular deterioration associated with hypertension in patients with severe and moderately severe hypertension. Untreated patients with mild and moderately severe hypertension did not show the rapid renal deterioration that occurs in patients with more marked elevation of the blood pressure. The mortality was significantly lower in treated patients than in untreated patients. Renal deterioration was arrested and mortality reduced in patients with malignant hypertension who were treated. Five patients with hypertension due to unilateral renal artery occlusion were studied. Glomerular filtration rate and renal blood flow were reduced significantly in the contralateral kidney as a result of the severe hypertension exhibited by these patients. This vascular deterioration in the unoccluded kidney could be arrested and was partly reversible when the blood pressure was reduced effectively. These results indicate that renal deterioration can be arrested by effective treatment of hypertension and that the lives of hypertensive patients can thus be prolonged. It is recommended therefore that hypertensive vascular disease be treated vigorously and early in the hope of decreasing the morbidity and mortality which too commonly result from this disease.