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The Kidney in Hypertension: Treatment Strategies

As in any patient with hypertension, the first goal in the hypertensive patient with renal disease is to control the hypertension. The second goal is to reduce overall cardiovascular risk, which includes an increased likelihood of coronary events. The third goal is to minimize the likelihood that renal disease will progress, or minimize the rate of progression. There is substantial evidence to indicate that control of hypertension, however achieved, will slow the rate of progression of renal injury and destruction. Studies in animal models have indicated that angiotensin-converting enzyme inhibitors are more consistent in preventing progressive renal injury, and perhaps have a more sustained action than standard agents employed hitherto. In the patient with a clear indication for β-adrenergic blockade, such as a prior coronary event or angina pectoris, a β-adrenergic blocking agent should be employed. Preliminary, but intriguing, evidence is available to suggest that a β-adrenergic blocking agent that incorporates a vasodilator action may enjoy special benefits in terms of achieving the three goals. In the case of renal injury, completion of the studies required to prove this point will improve our ability to deal with the problem of hypertension in the patient with renal disease.