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The message for World Kidney Day 2009: hypertension and kidney disease: a marriage that should be prevented

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Introduction

The kidney is both a cause and victim of hypertension. High blood pressure (BP) is a key pathogenetic factor that contributes to deterioration of kidney function. The presence of kidney disease is a common and underappreciated pre-existing medical cause of resistant hypertension.1 Therefore, treatment of hypertension has become the most important intervention in the management of all forms of chronic kidney disease (CKD). For this reason, the forthcoming World Kidney Day on March 12th, 2009 will emphasize the role of hypertension for renal disease.

Section snippets

How Does One Recognize the Presence of Chronic Kidney Disease?

In contrast to a decade ago, today most laboratories around the world report estimated glomerular filtration rate (eGFR) instead of or in addition to serum creatinine. This now provides the physician with information about kidney function that is, in general, more informative. As a result, a greater percentage of patients with diabetes or hypertension and their physicians have a better knowledge of their kidney function. Assessment of eGFR as an index of kidney function should be complemented

What is the Worldwide Frequency of Chronic Kidney Disease?

The frequency of CKD continues to increase worldwide as does the prevalence of ESRD.4, 5 The most common, but not only, causes of CKD are hypertension and diabetes. The presence of CKD is associated with a large increase in cardiovascular (CV) risk. Moreover, CV risk increases proportionally as eGFR falls below 60 mL/min. Lastly, death from CV causes is higher in CKD and much higher than is cancer in CKD; as a result the identification and reduction of CKD has become a public health priority.6

The Role of Hypertension

Hypertension is a global problem, and the situation is projected to get worse. It is the major risk factor for development and progression in nondiabetic and diabetic CKD.

The world population is getting older and aging is the most common risk factor for the development of hypertension and diabetes as well as CKD. Nearly one billion people worldwide have high BP (defined as >140/90 mm Hg), and that number is expected to increase to 1.56 billion people by 2025.10 The prevalence of hypertension is

Which Blood Pressure Component is Most Relevant for Renal and Cardiovascular Risk, Systolic or Diastolic?

There is now consensus, based on the totality of the data, that systolic rather than diastolic BP poses the greater risk for cardiovascular events and kidney disease progression. Against this background, it is relevant that in the KEEP study elevated systolic BP accounted for the majority of patients with inadequate control. Male gender, non-Hispanic black race, and BMI of 30 kg/m2 or more were inversely related to BP control.

What is the BP target for CKD patients? According to the different

The Role of Diabetic Nephropathy

As indicated above, diabetes and hypertension are the most common causes of CKD. There are currently over 240 million people with diabetes worldwide. This figure is projected to rise to 380 million by 2025, largely due to population growth, aging, urbanization, unhealthy eating habits, increased body fat and a sedentary lifestyle. By 2025, the number of people with diabetes is expected to more than double in Southeast Asia, the Eastern Mediterranean and Middle East, and Africa. It is projected

The Remaining Challenge

Under diagnosis and under treatment of CKD is a worldwide problem: not only is CKD awareness low worldwide, but the relative lack of CKD risk factor awareness by physicians, i.e. hypertension and diabetes is even more disturbing. Moreover, even awareness of these risk factors does not ensure adequate treatment; this could relate either to the behavior of the patient, the provider, or both. Thus, the problem of CKD remains a challenge as exemplified by recent data showing that between 1999–2006,

What Can Be Done About this Problem?

There have been many consensus panels over the past decade to approach ways to achieve better BP control and educate physicians to the stages of CKD.13, 14 The road to improve outcomes is to focus on public awareness and screening programs as well as programs to educate both patients and physicians. Data from the KEEP screening program in the U.S. has also noted that BP values are most likely to be at goal once a patient is aware they have kidney disease.15 Data from Bolivia highlights the

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Reprinted with Permission from Archives of Iranian Medicine, Vol. 12, No. 1 January 2009, pgs. 102–105.

Conflict of interest: none.

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