More aggressive BP lowering urged for adults with renal insufficiency

By Faith Reidenbach

NEW YORK (Reuters Health) – Earlier referral to a nephrologist and more aggressive blood pressure lowering is warranted for many adult hypertensives with chronic renal insufficiency, US researchers urge.

In a review the records of 3089 hypertensive outpatients treated at Brigham and Women's Hospital in Boston, Dr. Chi-yuan Hsu and colleagues found that blood pressure control was suboptimal among those with renal insufficiency, although on average it was no worse than in those with preserved renal function. The final blood pressure reading was 60 mL/min, 38% received an ACE inhibitor, compared with 36% of those with CrCl 41 to 60 mL/min and 27% of those with CrCl 21 to 40 mL/min (p = 0.003 for trend).

All patients with renal insufficiency are potential candidates for an ACE inhibitor, Dr. Hsu said. "This should be the first drug class of choice. This is a much misunderstood point because it is wrongly believed that ACE inhibitors are contraindicated in renal insufficiency. Very rarely, there is a temporary decline in kidney function or hyperkalemia with use of ACE inhibitors but these can usually be managed safely."

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