European Heart Journal Advance Access originally published online on July 8, 2005
European Heart Journal 2005 26(24):2616-2622; doi:10.1093/eurheartj/ehi414
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Preserving cardiac function in the hypertensive patient: why renal parameters hold the key
Cardiac Care Unit, Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, 47 Boulevard de l'Hôpital, 75013 Paris, France
Received 22 December 2004; revised 10 May 2005; accepted 16 June 2005; online publish-ahead-of-print 8 July 2005.
* Corresponding author. Tel: +33 1 42 16 30 06; fax: +33 1 42 16 29 31. E-mail address: gilles.montalescot{at}psl.ap-hop-paris.fr
The relationship between cardiovascular and renal pathologies is well recognized in advanced nephropathy and heart failure, but in early disease it has received less attention. Consequently, microalbuminuria screening and interventions that treat early nephropathy remain under-utilized cardioprotective strategies in the hypertensive patient. Agents that delay the progression of renal disease are likely to be cardioprotective by lessening the systemic consequences of renal dysfunction and may have additional cardioprotective effects by exerting beneficial effects on endothelia elsewhere in the body and within the heart. A critical driving factor within both renal and wider cardiovascular pathologies is overactivation of the renin–angiotensin–aldosterone system (RAAS). Accordingly, RAAS-directed antihypertensive agents including both angiotensin converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) have been demonstrated to have renoprotective effects. In major prospective trials, two ARBs, losartan and irbesartan, have been demonstrated to be renoprotective in patients with frank proteinuria, and one ARB, irbesartan, has been shown to have renoprotective properties in patients with microalbuminuria. For patients with incipient or frank renal dysfunction, an aggressive RAAS-based approach to hypertension management, combining potent blood pressure control with proven renoprotection, may therefore constitute a key component of therapy targeted towards long-term cardioprotection.
Key Words: Cardiovascular disease • Hypertension • Microalbuminuria • Renin–angiotensin–aldosterone system • Angiotensin receptor blockers • ACE-inhibitors
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