Primary hypertension and nephropathy

PURPOSE OF REVIEW: The relationship between primary hypertension (formerly called essential hypertension) and hypertension-associated chronic kidney disease is complex and poorly understood. The strong association between hypertension-associated chronic kidney disease and cardiovascular disease supports the existence of common mediators. We will review data indicating common mediating mechanisms for cardiovascular disease and chronic kidney disease in primary hypertension. RECENT FINDINGS: Chronic kidney disease develops in primary hypertension due to local and systemic inflammatory mediators that cause endothelial injury. This injury is an important early step in the development of hypertension-associated vasculopathy that causes nephron ischemia with nephrosclerosis. Similar mechanisms mediate endothelial injury in cardiovascular disease and its progression. Subjects with primary hypertension at increased risk for chronic kidney disease are at higher risk for cardiovascular disease, the major cause of mortality in primary hypertension. SUMMARY: Primary hypertension is a modifiable risk factor for both cardiovascular disease and chronic kidney disease. Better understanding of how primary hypertension leads to these outcomes might help in the development of pharmacologic strategies that retard and/or prevent chronic kidney disease in primary hypertension. Because of the strong association between cardiovascular disease and chronic kidney disease in primary hypertension, this improved understanding will likely lead to better therapies to hinder the development and/or progression of cardiovascular disease, in addition to its benefits in preventing hypertension-associated chronic kidney disease.