How to prevent organ damage in patients with hypertension - focusing on the kidneys

Renal impairment is one of the underestimated risks of uncompensated hypertension. Long-term adverse effects of high blood pressure are risky from a young age. Early diagnosis and consistent treatment of hypertension are needed in the prevention of hypertensive kidney damage. According to the new recommendations, treatment should be guided to target BP values < 130/80 mmHg, which should be optimally achieved within 3 months of therapy. In addition, it is recommended that every hypertensive patient be examined glomerular filtration rate and albuminuria (using the albumin : creatinine ratio in the urine) at least once a year. In the management of patients with hypertension and chronic renal insufficiency, blood pressure compensation, salt restriction, and the selection of nephroprotectives, especially the use of non-fetal antihypertensives, where ACEIs should be titrated to the highest tolerated dose, are essential. In the second step of the treatment of hypertension, a triple combination of antihypertensive drugs is recommended. If it is insufficient, spironolactone is most often added. Of the diuretics, thiazide and thiazide-like diuretics should be preferred, only in hypervolemia, advanced renal insufficiency, or heart failure furosemide is suitable. When calculating the cardiovascular risk of hypertensive patients, the presence of albuminuria should be taken into account and a statin should be administered in patients at high CV risk.

Keywords: hypertension, chronic renal insufficiency, proteinuria, antihypertensive treatment.