Treatment of hypertension in patients with chronic renal failure

Patients with chronic renal failure (CRF) should be classified in three categories: (i) those with renal insufficiency of various degrees, (ii) those receiving haemodialysis or peritoneal dialysis, and (iii) the renal graft recipients (RGR) in whom there is almost always some degree of renal insufficiency. Cardiovascular disease (CVD) is the leading cause of death in CRF patients w1x with a death rate of 3.5 times higher compared with that of a non-renal cohort with similar ages w2x. Hypertension, which is an important risk factor for morbidity and mortality from CVD in the general population, is an extremely common finding in CRF patients with a prevalence ranging from 60 to 100%, depending on the target population w3x. Although there is substantial experimental and clinical evidence that controlling blood pressure will slow the decline in renal function in patients with renal insufficiency w4–7x, the reports on the relationship between blood pressure and CVD mortality in dialysis patients are conflicting.