Hypertension and kidney stones: hypotheses and implications

Abstract

A statistical association between arterial hypertension and kidney stone disease has been observed in three retrospective epidemiological surveys: the first was conducted in the early 1960s on 895, 50-year-old men living in Goteborg, Sweden; the second on 3,431 in-wall residents of the ancient town of Gubbio in central Italy, and the third on 688 workers (88% of the male work force) of the Olivetti factory in Pozzuoli, Naples, Italy. In all three studies, the participants in the upper part of the respective blood pressure distributions, or on long-term treatment for arterial hypertension had a significantly higher frequency of a positive history of nephrolithiasis compared with normotensives. This statistical association was independent of age, body mass, and biochemical indicators of renal function. The aim of this article is to review the evidence provided by these epidemiological surveys and to discuss a few pathogenetic hypotheses with special reference to the role of hypercalciuria and other alterations of calcium metabolism commonly found in patients with essential hypertension. The higher risk of calcium nephrolithiasis in hypertensive patients has obvious clinical and public health implications, given the large diffusion of both conditions in the population and the elevated social costs of their complications and sequelae. Several nutritional measures are known to be effective for the prevention and treatment of both hypertension and nephrolithisis, and therefore, there is attention in this article to the important role of the micronutrients sodium, potassium, and calcium and to their biological relationships.