Hypertensive renal damage.

The primary focus of both nonpharmacologic and pharmacologic therapy should be to control systemic blood pressure in a simple, affordable, and nontoxic fashion that provides an adequate quality of life. Although newer agents provide hope for greater capability of preventing renal dysfunction, their cost may prevent their broad availability in the black hypertensive population (see Chapter 5). Judicious use of traditional therapies, combined with newer approaches when possible, may offer prescribing physicians the best opportunity to control blood pressure in ways to avoid renal dysfunction. The lessons of the past 20 years have taught us that lowering blood pressure by any means helps in reducing target organ damage. More recent observations in hypertensive blacks illustrate the need for improved therapies to prevent renal dysfunction. A more physiologic approach to blood pressure control in the black patient that conserves perfusion to the kidney may delay the development of nephrosclerosis. Increased awareness, educational support, and encouragement will be necessary to insure compliance with therapy for a disease that is largely asymptomatic.