Hypertension in chronic renal failure and ESRD: Prevalence, pathophysiology, and outcomes

Hypertension and cardiovascular disease were detected to be major problems in end-stage renal disease patients soon after the application of chronic dialysis to treat uremia. Nearly 40 years later, and despite awesome technological and pharmacological advances, cardiovascular diseases remain the number one cause of death in all categories of renal patients, ie, chronic renal insufficiency, end-stage renal disease on dialysis and the renal transplant recipient. This is quite likely related to the massive clinical burden of cardiovascular risk factors: hypertension, cardiac fibrosis and hypertrophy, abnormal lipid profiles, smoking, dietary factors, and enhanced sympathetic activity. For example, left ventricular hypertrophy and abnormal echocardiograms are present in up to 75% to 80% of incident dialysis patients related to the interactions of these cardiovascular risks. It is important to understand how hypertension and the other cardiovascular disease risk factors interact in these patients. Based on the latest national data from the USRDS, the prevalence of underlying cardiac disease is increasing during the period of chronic renal failure. A proper understanding of the pathophysiology and prevalence of hypertension and its consequences in renal patients may lead to more rational therapies and clinical trials. At this time, the nephrologists are dealing with an epidemic of cardiovascular diseases in their patients.