Hypertension in patients with polycystic kidney disease – incidence, pathogenesis, prognosis, therapy

Czech version

Authors: V. Tesař; J. Reiterová
Authors‘ workplace: Klinika nefrologie 1. lékařské fakulty UK a VFN v Praze, přednosta prof. MU Dr. Vladimír Tesař, DrSc., MBA
Published in: Vnitř Lék 2013; 59(6): 496-500
Category: 80th birthday prof. MUDr. Karla Horkého, DrSc., FACP (Hon.)

Overview

Hypertension is common in patients with autosomal dominant polycystic kidney disease (ADPKD) very early usually already in adolescence and its occurrence precedes the decrease of glomerular filtration rate. Expansion of renal cysts causing local renal ischemia and activation of the renin‑angiotensin system is believed to play a decisive role in its pathogenesis. Hypertension in ADPKD leads to early development of left ventricle hypertrophy and definitely contributes to the progression of chronic renal insufficiency. In ADPKD optimal control of blood pressure dramatically decreases the risk of left ventricle hypertrophy and contributes to its regression, but the beneficial effect of optimal compared to standard blood pressure control on the progression of chronic renal insufficiency has yet to be unequivocally demonstrated. Angiotensin converting enzyme inhibitors and/ or angiotensin receptor blockers are the drugs of choice in the treatment of hypertension in ADPKD. New drugs blocking the growth of renal cysts (e. g. inhibitors of V2 vasopressin antagonists) may have in ADPKD positive impact not only of the growth of the cysts and kidney volume, but also on the rate of loss of glomerular filtration rate. The influence of these drugs on the control of blood pressure, if any, remains uncertain.

Key words:
autosomal dominant polycystic kidney disease – hypertension – treatment of hypertension in ADPKD

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