Hypertension and the kidney: an update

Arterial hypertension is the top risk factor for attributable deaths.The kidney and hypertension are intimately ligated.Thus, a defective kidney function contributes to the initial increase in blood pressure (BP) while arterial hypertension promotes the development and progression of left ventricular hypertrophy and chronic kidney disease (CKD), being the second cause of kidney failure after diabetes mellitus, which itself is very frequently accompanied by arterial hypertension. 1Chronic kidney disease is now defined as the persistent presence of low kidney function with low glomerular filtration rate (GFR) and/or evidence of kidney damage (e.g. as reflected by a urinary albumin:creatinine ratio above 30 mg/g or other laboratory or imaging criteria). 2Both arterial hypertension and CKD cooperate to promote the development and progression of cardiovascular disease, 2 indicating the need to simultaneously control high BP, slow the loss of GFR, decrease albuminuria, and correct other risk factors associated to cardiorenal diseases such as hyperlipidaemia, diabetes mellitus, obesity, and smoking, among others within the wider frame of cardiovascular-kidney-metabolic health (Figure 1), as recently emphasized by the USA cardiovascular-kidneymetabolic health presidential advisory. 3rterial hypertension may present different phenotypes that should be treated and controlled, including masked and nocturnal hypertension and high BP variability.These phenotypes are more prevalent in the presence of cardiorenal disease. 4Given the existence of phenotypes not identifiable by office BP assessment, ambulatory (preferably) or home BP monitoring is required to confirm optimal BP control and adjust therapy if control is suboptimal.Importantly, the prevalence of arterial hypertension has increased significantly in recent decades especially in children and young persons because of the increasing prevalence of obesity, high dietary sodium intake, sedentary lifestyle, and perinatal (e.g.prematurity resulting in low nephron numbers) and socio-economic factors.Therefore, paediatric hypertension is a major public problem that, if uncontrolled, contributes to subclinical cardiovascular disease and is a relevant risk factor for kidney dysfunction. 5n fact, a rapid rise in hypertension and nephropathy is frequently observed in type 2 diabetes in the young. 6Implementation of adequate