Preventing Hypertensive Kidney Disease: The Critical Role of Combination Therapy

T he recent publication by the National Kidney Foundation (NKF) of clinical practice guidelines for hypertension and antihypertensive agents in chronic kidney disease (CKD) highlights mounting evidence that we have the means to improve outcomes for individuals with CKD; at the same time, it raises the question of whether we have the will to do so. Like hypertension itself, CKD may progress silently over many years, and therefore its prevention, detection, and treatment depends largely on the vigilance of physicians and other health care providers. High blood pressure is both a cause and a complication of CKD and is associated with progression to kidney failure and an extraordinarily high incidence of cardiovascular morbidity and mortality. For these reasons, patients with CKD should be considered among the highest-risk groups for cardiovascular disease (CVD). This supplement represents the proceedings of a continuing medical education symposium, Preventing Hypertensive Kidney Disease: The Critical Role of Combination Therapy, sponsored by the NKF during their 2004 Clinical Meetings held April 28 to May 2, 2004, in Chicago, IL. We offer it with the hope that insights regarding the treatment of hypertension in CKD and in those at greatest risk for CKD will be solidly incorporated into the practices of professionals most intimately involved in treating patients with CVD. Several large, randomized, controlled trials have provided data regarding the effect of antihypertensive therapy on the development and progression of CKD. Nonetheless, the relationships among CKD “progression factors” are complex, and many questions remain unanswered. Thus, the article by Dr. Leopoldo Raij, which provides a fascinating discussion of the complex interactions among hemodynamic, hormonal, and metabolic mechanisms responsible for renal injury, is a welcome introduction to the topic. In his intriguing article, Dr. Raij provides an excellent theoretical background for understanding the role of renin-angiotensin system (RAS) blockade in preventing progressive renal damage.