Vnitr Lek 1993, 39(8):810-816

[Treatment of hypertension in kidney diseases].

K Horký, R Dzúrik, V Fedelesová: II. interní klinika 1. lékarské fakulty University Karlovy, Praha.

The authors review recent therapeutic procedures in arterial hypertension associated with renal disease. Treatment of hypertension is comprehensive, it comprises non-medicamentous procedures, pharmacotherapy and in some affections also interventional and surgical therapy. Effective reduction of the blood pressure to values < or = 140/90 mmHg unequivocally retards progression of renal disease, the development of nephrosclerosis and delays the development of renal insufficiency. In medicamentous treatment of nephrogenic hypertension a wide range of conventional antihypertensive drugs is used. Their selection and dosage must be adapted to the type of the basic renal disease and the reduction of renal functions. Recently the demand has been raised that the antihypertensive drugs used should possess in addition to the blood pressure lowering effect also an additive renoprotective effect ensuing above all from diminished intraglomerular hypertension and undesirable hyperfiltration, a changed permeability of capillary membranes due to reduction of microalbuminuria and proteinuria or restriction of proliferation procedures. These demands are met by the angiotensin I-converting enzyme (ACEI) inhibitor. If the correct dosage is used, ACEI are, due to their excellent antihypertensive action, absence of undesirable metabolic sequelae and significant renoprotective effect, drugs of the first line in nephrogenic hypertension. The authors use above all ACEI with a long-term effect, i.e. those without a SH group in the molecule. Very small doses (e.g. 2.5 mg Enalapril per day) reduce microalbuminuria and proteinuria and retard progression of nephrosclerosis also in nephropathies without systemic hypertension, e.g. in diabetic glomerulosclerosis. The renoprotective effect is manifested more markedly in initial stages of the disease.(ABSTRACT TRUNCATED AT 250 WORDS)