Does treated primary hypertension lead to end-stage renal disease? A 20-year follow-up of the Primary Prevention Study in Göteborg, Sweden

Autor: Lars Wilhelmsen, Susanne Ljungman, Annica Siewert-Delle, Ove K. Andersson
Rok vydání: 1998
Předmět:
Zdroj: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 13(12)
ISSN: 0931-0509
Popis: study of white middle-aged men with primary non- malignant hypertension was that long-term antihyper- Background. Hypertension is reported to be one of the most common causes of end-stage renal disease tensive treatment was not associated with development of end-stage renal disease or even an abnormal pro- ( ESRD) in Europe and in the United States. However, the frequency with which treated primary hypertension gressive decline in kidney function. leads to renal failure is not known. The majority of patients with ESRD have hypertension. Whether this Key words: primary hypertension; renal function; is the cause or the consequence of the impaired renal antihypertensive treatment; population-based; epi- function is often not possible to establish. demiology Methods. To determine if treated primary hypertension can lead to ESRD, we studied the development of serum creatinine levels in 686 white hypertensive men, recruited from a random third of the male population Introduction aged 47-55 years living in Goteborg, Sweden (n= 9998; 7495 participants). At entry and during 20 years During the past 30 years, there has been an increasing follow-up, all signs of kidney disease, secondary hyper- awareness that hypertension is a major public health tension, or increase in blood pressure were investigated. problem and that its treatment is beneficial. In the Records of patients with a serum creatinine value populations of the industrialised societies, blood pres- 130 mmol/l at any time during the observation period sure rises with age, reaching the cut-oV level of hyper- were thoroughly studied to ascertain the cause of the tension in almost 40% of subjects aged over 60 years impaired renal function. (1). As a result of the awareness of hypertension and Results. A serum creatinine level above 130 mmol was its cardiovascular consequences, the availability of seen in 8.9% (61/686) of the treated hypertensives eVective antihypertensive drugs and the reduction of during the 20 years of follow-up. An underlying renal untreated hypertensives, the morbidity and mortality disorder was found in 7.2% (49/686) of the patients; from stroke, and to a lesser extent, coronary heart renoparenchymal disease (2.2%), renovascular disease disease, have declined. However, the number of sub- (1.5%), diabetic nephropathy (1.2%) or a urological jects who develop end-stage renal disease ( ESRD) as disease (1.6%). Only 1.7% (12/686) of the hypertensives a consequence of hypertension has been reported to showed a moderate progressive increase in serum creat- increase and to account for about 20% of new patients inine of unknown cause. The serum creatinine in this with ESRD in need of dialysis or kidney transplanta- group was 133±8 mmol/l (mean±SD; range 124-144) tion in Europe (2) and between 25 and 30% in the after 15 years and 139±7 mmol/l (range 132-151) after United States (3). Before eVective antihypertensive 20 years. Thus, none of these patients aged 66-71 treatment was available, impaired renal function and years had developed ESRD or a clinically important uraemia was a common complication of primary hyper- reduction in renal function.
Databáze: OpenAIRE
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