Nephrology Dialysis Transplantation, Vol 13, Issue 12 3084-3090, Copyright © 1998 by Oxford University Press
A Siewert-Delle, S Ljungman, O Andersson and L Wilhelmsen
Background. Hypertension is reported to be one of the
most common causes of end-stage renal disease (ESRD) in Europe and in the
United States. However, the frequency with which treated primary
hypertension leads to renal failure is not known. The majority of patients
with ESRD have hypertension. Whether this is the cause or the consequence
of the impaired renal function is often not possible to establish.
Methods. To determine if treated primary hypertension
can lead to ESRD, we studied the development of serum creatinine levels in
686 white hypertensive men, recruited from a random third of the male
population aged 47-55 years living in Goteborg, Sweden
(n=9998; 7495 participants). At entry and during 20
years follow-up, all signs of kidney disease, secondary hypertension, or
increase in blood pressure were investigated. Records of patients with a
serum creatinine value ⩾130 &mgr;mol/l at any time during the
observation period were thoroughly studied to ascertain the cause of the
impaired renal function. Results. A serum creatinine
level above 130 &mgr;mol was seen in 8.9% (61/686) of the treated
hypertensives during the 20 years of follow-up. An underlying renal
disorder was found in 7.2% (49/686) of the patients; renoparenchymal
disease (2.2%), renovascular disease (1.5%), diabetic nephropathy (1.2%) or
a urological disease (1.6%). Only 1.7% (12/686) of the hypertensives showed
a moderate progressive increase in serum creatinine of unknown cause. The
serum creatinine in this group was 133±8 &mgr;mol/l
(mean±SD; range 124-144) after 15 years and 139±7
&mgr;mol/l (range 132-151) after 20 years had developed ESRD or a
clinically important reduction in renal function. Conclusion.
The main finding in this population-based study of white
middle-aged men with primary non-malignant hypertension was that long-term
antihypertensive treatment was not associated with development of end-stage
renal disease or even an abnormal progressive decline in kidney function.
Keywords: primary hypertension; renal function;
antihypertensive treatment; population-based; epidemiology
ORIGINAL ARTICLES
Does treated primary hypertension lead to end-stage renal disease? A 20-year follow-up of the primary prevention study in Goteborg, [Sweden]
Department of Nephrology, Department of Medicine, Hypertension Clinic, and Preventive Cardiology, Sahlgrenska University Hospital, S-413 45, Goteborg, Sweden; Corresponding author
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