Physicians should continue antihypertensive treatment in patients with hypertension and renal insufficiency even if serum creatinine increases, as this reflects successful reduction of intraglomerular pressure.
In patients with hypertension and renal insufficiency, there is often an increase in the serum creatinine concentration as the blood pressure is lowered. Physicians may respond by reducing antihypertensive treatment. However, as this review explains, the decline in renal function is hemodynamic in origin and is due to changes in renal autoregulation. Such an increase in creatinine should be recognized as a sign that the intraglomerular pressure has been successfully reduced, and the physician should continue antihypertensive treatment.
Biff F. Palmer (2002) studied this question.