Renal insufficiency in treated essential hypertension

Article Abstract:

Malignant hypertension, or high blood pressure, can cause severe kidney dysfunction. Treatment with drugs has been shown to stop the progression of kidney damage or even improve kidney function. However, primary hypertension with other causes, such as poor sodium excretion, can also damage the kidney. Despite the successful use of drugs to control high blood pressure, their ability to prevent or improve kidney deterioration in these latter patients has not been so convincing. Factors influencing the deterioration of kidney function in patients with primary hypertension were examined in 94 patients. Of these patients, 15 percent had some degree of impaired kidney function. Out of 61 patients with controlled high blood pressure (diastolic pressure of less than 90 mm Hg), 16 percent had deteriorating kidney function. The remaining 33 patients, who had poor blood pressure control, had insufficient kidney function in 12 percent. Results indicate that black patients were almost two times more likely to have impaired kidney function than white patients. Older people, people missing office visits and workers who performed physical labor were more likely to have insufficient kidney function. Results suggest that with adequate management of blood pressure, 85 percent of people with primary hypertension can maintain good kidney function. For black people, however, hypertension is still a leading cause of death.

Measurement, Blood pressure, Creatinine, Kidney function tests, Blood pressure measurement

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The kidney in hypertension - villain and victim

Article Abstract:

The two types of hypertension are primary, which is caused by poor salt excretion, and secondary, which is caused by a diseased kidney itself. High blood pressure in turn may cause continued decreased kidney function and hasten kidney damage. A recent study by Rostrand looks at the effect high blood pressure control has on the development of kidney damage. It was found that blood pressure control did not influence kidney function but the loss of kidney function was 2.1 times higher in blacks than in whites. A few factors limit the efficacy of this study. The use of outpatient blood pressure measurements, which are generally lower than office visit values, may have influenced study results. In addition, blood pressures may not have been lowered enough to prevent kidney involvement and the values used for determining kidney function may vary with patient age. The study nevertheless indicates the need for reevaluation of current standards of blood pressure reduction, especially in black patients.

Hypertension, Causes of, editorial, Nephrosclerosis

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Race and health care - an American dilemma?

Article Abstract:

Physicians need to address at the most basic level the racial discrimination that appears to exist in the US health care system. A 1996 study of 26 million Medicare beneficiaries confirmed many other studies when it showed that blacks were less likely to receive optimal medical care than whites. Studies have repeatedly shown that blacks with heart disease are less likely to receive angioplasty or coronary artery bypass surgery. Blacks with higher incomes receive better care but not equal to the care high-income whites receive. Health care providers need to root out discriminatory practices and medical schools need to teach cultural sensitivity.

Editorial, Medical care, Medical care utilization

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