Hypertension and the Kidney

BACKGROUND AND OBJECTIVES: The kidney is important not only in the genesis of blood pressure elevation, but declining renal function is also important for predicting cardiovascular risk. The primacy of the kidney in causing essential hypertension was a topic of debate until the proof-of-principle experiment was performed, which demonstrated remission of essential hypertension in six African-American hypertensives with ESRD after they received successful kidney transplants from normotensive donors. The resolution of hypertension and hypokalemia in a patient with Liddle's syndrome and ESRD after subsequent successful renal transplantation also demonstrated the primacy of the kidney in a monogenic form of hypertension related to sodium epithelial channel dysfunction. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A review of the available evidence linking cardiovascular disease with chronic kidney disease. RESULTS: The cause for the inverse continuous relationship between kidney function and cardiovascular events in patients with native kidney disease and kidney transplant recipients is unknown but may be related to traditional and nontraditional cardiovascular risk factors. This is an important clinical concern and requires close attention to cardiovascular risk reduction measures. CONCLUSIONS: Increased cardiovascular disease in patients with chronic kidney disease is an important clinical concern. Improved biomeasures of cardiovascular risk and response to therapy are needed.