nach oben

International Urology and Nephrology

Erschienen in:

01.06.2007 | Review

Hypertension and kidney protection in the elderly: what is the evidence in 2007?

verfasst von: Robert D. Lindeman

Erschienen in: International Urology and Nephrology | Ausgabe 2/2007

Einloggen, um Zugang zu erhalten

Abstract

Hypertension and diabetes mellitus are the two most widely recognized risk factors for cardiovascular disease (CVD), chronic kidney disease (CKD), and end-stage renal disease (ESRD) requiring dialysis/transplantation; both become increasingly important as one ages. Common pathways and mechanisms are involved in the development of renal vascular lesions in both conditions, and effective treatments for each are now available to reduce morbidity, mortality and progression of organ damage. Although this review will focus primarily on the ability to protect the kidney and vasculature elsewhere by lowering blood pressure in the elderly, other approaches, specifically dietary restriction of protein, strict control of diabetes mellitus, and the management of the different dyslipidemias, must be used in conjunction with the antihypertensive agents to obtain optimum protection.

Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL (2003) The seventh report of the joint national committee on prevention, detection, evaluation and treatment of high blood pressure; the JNC7 report. JAMA 289:2560–2572PubMedCrossRef

SHEP Cooperative Research Group (1991) Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). JAMA 265:3255–3264CrossRef

Medical Research Council trial of treatment of hypertension in older adults: principal results (1992) MRC working party. Br Med J 304:405–412

Dahlof B, Lindholm LH, Hannson L, Schersten B, Ekbom T, Wester PO (1991) Morbidity and mortality in the Swedish Trial in Old Patients with Hypertension (STOP – Hypertension). Lancet 338:1281–1285PubMedCrossRef

Staessen JA, Fagard J, Thys L, Celis H, Arabidze GG, Birkenhager WH, Bulpitt CJ, de Zeeuw PW, Dollery CJ, Fletcher AE, Forette F, Leonetti G, Nachev C, O’Brien ET, Rosenfeld J, Rodicio JL, Tuomilehto J, Zanchetti A (1997) Randomized double blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Investigators. Lancet 350:757–764PubMedCrossRef

Liu L, Wang JG, Gong L, Liu G, Staessen JA (1998) Comparison of active treatment and placebo in older Chinese patients with isolated systolic hypertension. Systolic Hypertension in China (Syst-China) Collaborative Group. J Hypertens 16:1823–1829PubMedCrossRef

Bidani AK, Griffin KA (2004) Pathophysiology of hypertensive renal damage: implications for therapy. Hypertension 44:595–601PubMedCrossRef

Wenzl RR (2005) Renal protection in hypertensive patients: selection of antihypertensive therapy. Drugs 65(suppl 2):29–39

Campbell RC, Ruggenenti P, Remuzzi G (2002) Halting the progression of chronic nephropathy. J Am Soc Nephrol 13(Suppl 3):S190–S195PubMedCrossRef

10.

Hostetter T, Rennke H, Brenner B (1982) The case for intrarenal hypertension in the initiation and progression of diabetic and other glomerulopathies. Am J Med 72:375–380PubMedCrossRef

11.

Graciano ML, di Cassia Cavaglieri R, Delle H, Dominguez WV, Casarini DE, Malheiros DM, Noronha IL (2004) Intrarenal renin-angiotensin system is upregulated in experimental model of progressive renal disease induced by chronic inhibition of nitrous oxide system. J Am Soc Nephrol 15:1805–1815PubMedCrossRef

12.

Agewall S, Wilkstrand J, Ljungman S, Fagerbaerg B (1997) Usefulness of microalbuminuria in predicting cardiovascular mortality in treated hypertensive men with and without diabetes mellitus. Am J Cardiol 80:164–169PubMedCrossRef

13.

deZeeuw D, Remmuzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, Snapinn S, Cooper ME, Mitch WE, Brenner BM (2004) Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation 110:921–927CrossRef

14.

Ruggenenti P, Perna A, Gherardi G, Garini G, Zoccoli C, Salvadori M, Scolari F, Scherra FP, Remuzzi G (1999) Renoprotective effects of ACE-inhibition in non-diabetic nephropathies with non-nephrotic proteinuria. Lancet 354:359–364PubMedCrossRef

15.

Jafar TH, Schmid CH, Laveda M, Giatras I, Toto R, Remuzzi G, Maschio G, Brenner BM, Kamper A, Zuchelli P, Becker G, Himmelman A, Bannister K, Landais P, Shahinfar S, de Jong PE, de Zeeuw D, Lau J, Levey AS (2001) Angiotensin converting enzyme inhibitors and the progression of non-diabetic renal disease: a meta-analysis of patient level data. Ann Intern Med 135:73–87PubMed

16.

Peterson JC, Adler S, Burkart JM, Greene T, Hebert LA, Hunsicker LG, King AJ, Klahr S, Massry SG, Seifter JL (1995) Blood pressure control, proteinuria, and the progression of renal disease. The Modification of Diet in Renal Disease Study. Ann Intern Med 123:754–762PubMed

17.

Sarnak MJ, Greene T, Wang X, Beck G, Kusek JW, Collins AJ, Levey AS (2005) The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the modification of diet in renal disease study. Ann Intern Med 142:342–351PubMed

18.

Pohl MA, Blumenthal B, Cordonnier DJ et al for the Collaborative Study Group (2005) Independent and additive impact of blood pressure control and angiotensin II receptor blockade on renal outcomes in the Irbesartan Diabetic Nephropathy Trial. J Am Soc Nephrol 16:3027–3037

19.

Wright JT Jr, Bakris G, Greene T, Agodoa LY, Appel LJ, Charleston J, Cheek D, Douglas-Baltimore JG, Gassman J, Glassock R, Herbert L, Jamesson K, Lewis J, Phillips RA, Toto RD, Middleton JP, Rostrand SG, African American Study of Kidney Disease and Hypertension Study Group (2002) Effect of blood pressure lowering and antihypertensive drug class on progression of kidney disease: results from the AASK trial. JAMA 288:2421–2431

20.

Maschio G, Alberti D, Janin G, Locatelli F, Mann JF, Motolese M, Ponticelli C, Ritz E, Zucchelli P (1996) Effect of angiotensin-converting enzyme inhibitor benazepril on the progression of chronic renal insufficiency. The Angiotensin-Converting Enzyme Inhibition in Progressive Renal Insufficiency Study Group. N Engl J Med 334:939–945PubMedCrossRef

21.

Schrier RW, Estacio RO (2001) The effect of angiotensin-converting enzyme inhibitors on the progression of non-diabetic renal disease. A pooled analysis of individual patient data from 11 randomized, controlled trials. Ann Intern Med 135:1073–1080

22.

Ruggenenti P, Perna A, Benini R, Bertani T, Zoccali C, Maggiore Q, Salvadori M, Remuzzi G (1999) In chronic nephropathies, prolonged ACE inhibition can induce remission: dynamics of time-dependent changes in GFR. Investigators of the GISEN Group. Gruppo Italiano di Studi Epidemiologici in Nefrologia. J Am Soc Nephrol 10:997–1006PubMed

23.

Maki DD, Ma JZ, Louis TA, Kasiske BL (1995) Long-term effects of antihypertensive agents on proteinuria and renal function. Arch Intern Med 155:1073–1080PubMedCrossRef

24.

Casas JP, Chua W, Loukogiogakis S, Vallance P, Smeeth L, Hingnani AD, Mac Allister RJ (2005) Effect of inhibitors of the renin-angiotensin system and other antihypertensive drugs on renal outcomes: systemic review and meta-analysis. Lancet 366:2026–2033PubMedCrossRef

25.

Heart Outcomes Prevention Evaluation Study Investigators (2000) Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICROHOPE sub-study. Lancet 355:253–259CrossRef

26.

Lewis EJ, Hunsicker LG, Clarke WR, Berl T, Pohl MA, Lewis JB, the Collaborative Study Group (2001) Renoprotective effect of angiotensin-receptor antagonist irbesartin in patients with nephropathy due to type 2 diabetes. N Engl J Med 345:851–860

27.

Blood Pressure Lowering Treatment Trialists Collaboration (2003) Effects of different blood pressure-lowering regimens on major cardiovascular events: results of prospectively-designed overviews of randomized trials. Lancet 362:1527–1535CrossRef

28.

ALLHAT officers, Coordinators for the ALLHAT Collaborative Research Group (2002) Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs. diuretic: the antihypertensive and lipid-lowering treatment to prevent heart attack trial. JAMA 288:2981–2997CrossRef

29.

Wing LMH, Reid CM, Ryan P, Ryan P, Beilin LJ, Brown MA, Jennings GL, Johnston CL, McNeil JJ, Macdonald GJ, Marley JE, Morgan TO, West MJ, Second Australian National Blood Pressure Study Group (2003) A comparison of outcomes with angiotensin-converting enzyme inhibitors and diuretic for hypertension in the elderly. N Engl J Med 348:583–592

30.

Doggrell SA (2003) Ace inhibitors versus diuretics: ALLHAT versus ANBP2. Expert Opin Pharmacother 4:825–828PubMedCrossRef

31.

Laragh JH (2001) Closing summary: clinical pearls for treating hypertension. Am J Hypertens 14:1173–1177PubMedCrossRef

32.

Rahman M, Pressel S, Davis BR, Nwachucku C, Wright JL Jr, Whelton PK, Barzilay J, Batuman V, Eckfeldt JH, Farber M, Henriquez M, Kokyt N, Louis GT, Saklayen M, Stanford C, Walworth C, Ward H, Wiegmann T, for the ALLHAT Collaborative Research Group (2005) Renal outcomes in high-risk hypertensive patients treated with angiotensin-converting enzyme inhibitor or calcium channel blocker vs. a diuretic: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) Collaborative Research Group. Arch Intern Med 165:936–946

33.

Rahman M, Pressel S, Davis BR, Nwachucku C, Wright JL Jr, Whelton PK, Barzilay J, Batuman V, Eckfeldt JH, Farber M, Franklin S, Henriquez M, Kokyt N, Louis GT, Saklayen M, Stanford C, Walworth C, Ward H, Wiegmann T, for the ALLHAT Collaborative Research Group (2006) Cardiovascular outcomes in high-risk hypertensive patients stratified by baseline glomerular filtration rate. Ann Intern Med 144:172–180

34.

Ritz E, McClellan WM (2004) Overview: increased cardiovascular risk in patients with minor renal dysfunction: an emerging issue with far-reaching consequences. J Am Soc Nephrol 15:513–516PubMedCrossRef

35.

Pinkau T, Hilgers KF, Veelken R, Mann JFE (2004) How does minor renal dysfunction influence cardiovascular risk and management of cardiovascular disease? J Am Soc Nephrol 15:517–523PubMedCrossRef

36.

Hollenberg NK, Epstein M (2006) Renin angiotensin system blockade and nephropathy: why is it being called into question and should it be? Clin J Am Soc Nephrol 1:1046–1048CrossRefPubMed

37.

Taal MW, Brenner BM (2000) Renoprotective effects of RAS inhibition from ACEI to angiotensin II antagonists. Kidney Int 57:1803–1817PubMedCrossRef

38.

Scheen AJ (2004) Prevention of type 2 diabetes mellitus through inhibition of the renin-angiotensin system. Drugs 64:2537–2565PubMedCrossRef

39.

Barnett AH, Bain SC, Bouter P, Karlong B, Madsbad S, Jervell J, Mustonen J (2004) Diabetics exposed to telmisartan and enalopril study group. Angiotensin-receptor blockade vs. converting enzyme inhibition in type 2 diabetes and nephropathy. N Engl J Med 351:1952–1961PubMedCrossRef

40.

Azizi M, Menard J (2004) Combined blockade of the renin-angiotensin system with angiotensin-converting enzyme inhibitors and angiotensin II type 1 receptor antagonists. Circulation 109:2492–2499PubMedCrossRef

41.

Tsouli SG, Liberopoulis EN, Kiortsis DN, Mikhailidis DP, Elisef MS (2006) Combined treatment with angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers: a review of current evidence. J Cardiovasc Pharmacol Therapeut 11:1–15CrossRef

42.

Nakao N, Yoshimura A, Morita H, Takada M, Kayano T, Ideura T (2003) Combination treatment of angiotensin-II receptor blocker and angiotensin-converting-enzyme inhibitor in non-diabetic renal disease (COOPERATE): a randomized controlled trial. Lancet 361:117–124PubMedCrossRef

43.

Kanno Y, Takenaka T, Nakamura T, Suzuki H (2006) Add-on angiotensin receptor blocker in patients who have proteinuric chronic kidney diseases and are treated with angiotensin-converting enzyme inhibitors. Clin J Am Soc Nephrol 1:730–737CrossRefPubMed

44.

Epstein M (2001) Aldosterone as a mediator of progressive renal disease: pathogenetic and clinical implications. Am J Kidney Dis 37:677–688PubMedCrossRef

45.

Hollenberg NK (2004) Aldosterone in the development and progression of renal injury. Kidney Int 66:1–9PubMedCrossRef

46.

Epstein M, Williams GH, Weinberger M, Lewin A, Krause S, Mukherjee R, Patni R, Beckerman B (2006) Selective aldosterone blockade with eplerenone reduces albuminuria in patients with type 2 diabetes. Clin J Am Soc Nephrol 1:940–951CrossRefPubMed

47.

Ponda MP, Hostetter TH (2006) Aldosterone antagonism in chronic kidney disease. Clin J Am Soc Nephrol 1:668–677CrossRefPubMed

48.

Schmidt BM, Sammer U, Fleischman I, Schlaich M, Delles C, Schmieder RE (2006) Rapid nongenomic effects of aldosterone on the renal vasculature in humans. J Hypertens 47:650–655CrossRef

49.

Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW, Striker G (1994) The effects of dietary protein restriction and blood pressure control on the progression of chronic renal disease. N Engl J Med 330:877–884PubMedCrossRef

50.

Kasiske BL, Lakatua JD, Ma JZ, Louis TA (1998) A meta-analysis of the effects of dietary protein restriction on the rate of decline in renal function. Am J Kidney Dis 31:954–961PubMed

51.

The Diabetes Control, Complications Trial Research Group (1995) Effect of intensive therapy on the development and progression of diabetic nephropathy in the diabetes control and complications trial. Kidney Int 47:1703–1720CrossRef

52.

Ohkubo Y, Kishakawa H, Araki E, Miyata T, Isami S, Motoyoshi S, Kojima Y, Furuyoshi N, Shichuri M (1995) Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin dependent diabetes mellitus. A randomized prospective 6-year study. Diabetes Res Clin Pract 28:103–117PubMedCrossRef

53.

Nosadini R, Tonolo G (2004) Relationship between blood glucose control, pathogenesis, and progression of diabetic nephropathy. J Am Soc Nephrol 15(Suppl 1):S1–S5PubMedCrossRef

54.

Mykkanen L, Zaccaro DJ, Wagenknect LE, Robbins DC, Gabriel M, Haffner SM (1998) Microalbuminuria is associated with insulin resistance in non-diabetic subjects: the Insulin Resistance Arteriosclerosis Study. Diabetes 47:793–800PubMedCrossRef

55.

Bakris G, Viberti G, Weston WM, Heise M, Porter LE, Freed MI (2003) Rosiglitazone reduces urinary albumin excretion in type 2 diabetes. J Hum Hypertens 17:7–12PubMedCrossRef

56.

Pistrosch F, Passauer J, Fischer S, Fuecker K, Hanefeld M, Gross P (2004) In type 2 diabetes, rosiglitazone therapy for insulin resistance ameliorates endothelial dysfunction independent of glucose control. Diabetes Care 27:484–490PubMedCrossRef

57.

Pistrosch F, Herbrig K, Kindel B, Passauer J, Fischer S, Gross P (2005) Rosiglitazone improves glomerular hyperfiltration, renal endothelial dysfunction, and microalbuminuria of incipient diabetic nephropathy in patients. Diabetes 54:2206–2211PubMedCrossRef

58.

Decker BS, Molitoris BA (2006) The role of statin therapy in patients with chronic kidney disease. Clin Geriatr 14:29–34

59.

Tonelli M, Moye L, Sacks F, Cole T, Curhan GC, for the Cholesterol, Recurrent Events (CARE) Trial Investigators (2003) Effect of pravastatin on loss of renal function in people with moderate renal insufficiency and cardiovascular disease. J Am Soc Nephrol 14:1605–1613

60.

Athyros VG, Mikhailidis DP, Papageorgiou AA, Symeonidis AN, Pehlivanidis AN, Bouloukos VI, Elisef MS (2004) The effect of statins versus untreated dyslipidemia on renal function in patients with coronary heart disease. A subgroup analysis of the Greek atorvastatin and coronary heart disease evaluation (GREACE) study. J Clin Pathol 57:728–734PubMedCrossRef

61.

Tonelli M, Keech A, Shepherd J, Sacks F, Tonkin A, Packard C, Pfeffer M, Simes J, Isles C, Furberg C, West M, Craven T, Curhan C (2005) Effect of pravastatin in people with diabetes and chronic kidney disease. J Am Soc Nephrol 16:3748–3754PubMedCrossRef

62.

Baigent C, Landry M (2003) Study of Heart and Renal Protection (SHARP). Kidney Int 84(Suppl):S207–S210CrossRef

63.

Bleyer AJ, Shemanski LR, Burke GL, Hansen KJ, Appel RG (2000) Tobacco, hypertension, and vascular disease: risk factors for renal functional decline in an older population. Kidney Int 57:2072–2079PubMedCrossRef

64.

Chaudhry SI, Krumholz HM, Foody JM (2004) Systolic hypertension in older persons. JAMA 292:1074–1080PubMedCrossRef

65.

Goodwin JS (2003) Embracing complexity: a consideration of hypertension in the very old. J Gerontol A Biol Sci Med Sci 58:653–658PubMed

66.

Messerli FH, Mancia G, Conti CR, Hewkin AC, Kupfer S, Champion A, Kooch R, Benetos A, Pepine CJ (2006) Dogma disputed: can aggressively lowering blood pressure in hypertensive patients with coronary artery disease be dangerous? Ann Intern Med 144:884–893PubMed

67.

Bulpitt C, Fletcher A, Beckett N, Cooke J, Gil-Extremera B, Forette F, Nachev C, Potter J, Sever P, Staessen J, Swift C, Tuomilehto J (2001) Hypertension in the very elderly trial (HYVET): protocol for the main trial. Drugs Aging 18:151–164PubMedCrossRef

68.

Bulpitt CJ, Beckett NS, Cooke J, Dimitrascu DL, Gil-Extremera B, Nachev C, Nunes M, Peters R, Staessen JA, Thijs L (2003) Hypertension in the Very Elderly Trial Working Group. Results of the pilot study for the Hypertension in the Very Elderly Trial. J Hypertens 21:2409–2417PubMedCrossRef

Titel: Hypertension and kidney protection in the elderly: what is the evidence in 2007?
verfasst von: Robert D. Lindeman
Publikationsdatum: 01.06.2007
Verlag: Kluwer Academic Publishers
Erschienen in: International Urology and Nephrology / Ausgabe 2/2007
Print ISSN: 0301-1623
Elektronische ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-007-9207-9

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Echinokokkose medikamentös behandeln oder operieren?

06.05.2024 DCK 2024 Kongressbericht

Die Therapie von Echinokokkosen sollte immer in spezialisierten Zentren erfolgen. Eine symptomlose Echinokokkose kann – egal ob von Hunde- oder Fuchsbandwurm ausgelöst – konservativ erfolgen. Wenn eine Op. nötig ist, kann es sinnvoll sein, vorher Zysten zu leeren und zu desinfizieren.

Umsetzung der POMGAT-Leitlinie läuft

03.05.2024 DCK 2024 Kongressbericht

Seit November 2023 gibt es evidenzbasierte Empfehlungen zum perioperativen Management bei gastrointestinalen Tumoren (POMGAT) auf S3-Niveau. Vieles wird schon entsprechend der Empfehlungen durchgeführt. Wo es im Alltag noch hapert, zeigt eine Umfrage in einem Klinikverbund.

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Die „Zehn Gebote“ des Endokarditis-Managements

30.04.2024 Endokarditis Leitlinie kompakt

Worauf kommt es beim Management von Personen mit infektiöser Endokarditis an? Eine Kardiologin und ein Kardiologe fassen die zehn wichtigsten Punkte der neuen ESC-Leitlinie zusammen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 2/2007

Brain metastases: a rare initial presentation of prostate cancer

Serum, urinary and stone zinc, iron, magnesium and copper levels in idiopathic calcium oxalate stone patients

No effect of serum parathyroid hormone level on antigen presenting cell-dependent T-cell reactivity in hemodialysis patients

Bladder erosion of tension-free vaginal tape presented as vesical stone; management and review of literature

The effect of external urethral sphincter contraction on the cavernosus muscles and its role in the sexual act