Antihypertensive therapy in the presence of proteinuria.

@article{Sarafidis2007AntihypertensiveTI,
  title={Antihypertensive therapy in the presence of proteinuria.},
  author={Pantelis A. Sarafidis and Nitin Khosla and George L. Bakris},
  journal={American journal of kidney diseases : the official journal of the National Kidney Foundation},
  year={2007},
  volume={49 1},
  pages={
          12-26
        }
}
The presence of proteinuria is a well-known risk factor for both the progression of renal disease and cardiovascular morbidity and mortality, and decreases in urine protein excretion level were associated with a slower decrease in renal function and decrease in risk of cardiovascular events. Increased blood pressure has a major role in the development of proteinuria in patients with either diabetic or nondiabetic kidney disease, and all recent guidelines recommend a blood pressure goal less… Expand
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Effects of angiotensin II receptor blockers on diabetic nephropathy
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References

SHOWING 1-10 OF 114 REFERENCES
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in chronic renal disease: safety issues.
TLDR
Although many studies demonstrate the use of ACE inhibitors and ARBs to delay the decline in renal function and reduce proteinuria, many physicians fail to use these drug classes in patients with renal insufficiency for fear that either serum creatinine or potassium levels will rise. Expand
Diabetic hypertensive patients: improving their prognosis.
TLDR
Retrospective analyses demonstrate that a reduction in blood pressure, especially to levels of <130/85 mg Hg in diabetic patients, retards the progression of renal disease. Expand
Proteinuria reduction and progression to renal failure in patients with type 2 diabetes mellitus and overt nephropathy.
  • R. Atkins, E. Briganti, +8 authors E. Lewis
  • Medicine
  • American journal of kidney diseases : the official journal of the National Kidney Foundation
  • 2005
TLDR
Baseline proteinuria is an important risk factor for kidney failure and provides a means to identify patients at greatest risk and proteinuria reduction using an angiotensin receptor-blocking agent, such as irbesartan, should be regarded as an important therapeutic goal in renoprotective strategies. Expand
Progression of Chronic Kidney Disease: The Role of Blood Pressure Control, Proteinuria, and Angiotensin-Converting Enzyme Inhibition: A Patient-Level Meta-Analysis
TLDR
This meta-analysis showed that systolic blood pressure and urinary protein excretion were related to the risk for renal disease progression in patients with nondiabetic kidney disease. Expand
Effects of losartan on renal and cardiovascular outcomes in patients with type 2 diabetes and nephropathy.
TLDR
Losartan conferred significant renal benefits in patients with type 2 diabetes and nephropathy, and it was generally well tolerated. Expand
Proteinuria, a target for renoprotection in patients with type 2 diabetic nephropathy: lessons from RENAAL.
TLDR
Albuminuria is the predominant renal risk marker in patients with type 2 diabetic nephropathy on conventional treatment; the higher the albuminuria, the greater the renal risk and the stronger the renal protection. Expand
The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy.
TLDR
Whether captopril has kidney-protecting properties independent of its effect on blood pressure in diabetic nephropathy is determined. Expand
Renal outcomes in high-risk hypertensive patients treated with an angiotensin-converting enzyme inhibitor or a calcium channel blocker vs a diuretic: a report from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT).
TLDR
In hypertensive patients with reduced GFR, neither amlodipine nor lisinopril was superior to chlorthalidone in reducing the rate of development of ESRD or a 50% or greater decrement in GFR. Expand
The relationship between magnitude of proteinuria reduction and risk of end-stage renal disease: results of the African American study of kidney disease and hypertension.
TLDR
Baseline proteinuria and GFR predicted the rgate of GFR decline and initial change in proteinuria from baseline to 6 months predicted subsequent progression, with this relationship extending to participants with baseline urinary protein levels less than 300 mg/d. Expand
Calcium Antagonists: Effects on Cardio-Renal Risk in Hypertensive Patients
TLDR
Calcium antagonists are safe and as efficacious as other antihypertensive agents to reduce cardiovascular risk but should be avoided in people with systolic dysfunction but may be used for blood pressure lowering inPeople with preserved syStolic function. Expand
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