What has changed in the current management of hypertension from the renal point of view?

Abstract

The European Society of Hypertension Task Force on the management of hypertension has recently reappraised the 2007 European guidelines. This reevaluation was based on a number of studies published in the previous 2 years. From a renal point of view, several conclusions of the reevaluation merit consideration. Firstly, the importance of including subclinical renal organ damage when evaluating total cardiovascular risk is reemphasized. Secondly, recommendations for reducing blood pressure to below 130/80 mmHg in diabetic and high-risk hypertensive patients (i.e., patients with renal damage) are critically reappraised, since the expected benefits are not consistently supported by trial evidence. Moreover, in these patients, the J-curve phenomenon may occur, thus compromising renal function. Thirdly, some of the drug combinations recommended in 2007 should be used with extreme precaution in hypertensive patients with renal involvement, especially those interfering with the renin-angiotensin system at different levels.