Kidney damage in 'benign' essential hypertension.

During the past 12 months additional evidence has emerged from observational studies indicating that high blood pressure is an important independent predictor of incident renal damage, progression of existing renal disease, and morbidity and mortality in patients with renal failure. Several of these studies suggest that elevation of systolic blood pressure is a stronger predictor of risk than a corresponding increase in diastolic blood pressure. Furthermore, the relationship between blood pressure and incident renal disease appears to be positive and continuous throughout the entire spectrum of blood pressure, including in the 'normotensive' range. Recent clinical trial experience in patients with renal insufficiency of diverse etiology supports the beneficial effect of treatment with angiotensin-converting enzyme inhibitors noted in earlier studies confined to patients with type II diabetes. Ongoing trials should help clarify optimal choice of antihypertensive medications and goals for reduction of blood pressure in prevention of renal disease. In the interim, two new guidelines for management of hypertension in patients with existing renal disease provide helpful guidance for the clinician.