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Review
. 2018 Nov;20(11):1560-1574.
doi: 10.1111/jch.13396. Epub 2018 Sep 28.

Antihypertensive treatment and renal protection: Is there a J-curve relationship?

Francesca Viazzi  1 , Giovanna Leoncini  1 , Guido Grassi  2   3 , Roberto Pontremoli  1
Affiliations
Review

Antihypertensive treatment and renal protection: Is there a J-curve relationship?

Francesca Viazzi et al. J Clin Hypertens (Greenwich). 2018 Nov.

Abstract

A bidirectional relationship between hypertension and kidney disease, with one exacerbating the effect of the other, is well established. Elevated blood pressure (BP) is a well-recognized, modifiable risk factor for cardiovascular (CV) disease as well as for development and progression of chronic kidney disease and, therefore, the identification of optimal BP target is a key issue in the management of renal patients. Recent large trials and real life cohort studies have indicated that below a definite BP value renal protection seems to plateau and too low levels may even be associated with a paradoxical increase in renal morbidity, thus reviving the debate about the so called BP -renal function J-curve relationship. Existing evidence supports a systolic target around 130 mm Hg to combine both renal and CV protection and possibly lower levels in the presence of overt proteinuria.

Keywords: J-curve relationship; RAAS-inhibition; albuminuria; chronic kidney disease; glomerular filtration rate; hypertension; target blood pressure.

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Conflict of interest statement

The authors report conflict of interest to disclose.

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