Hypertension and the Kidney

The prevalence of hypertension or high blood pressure (defined as systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) worldwide exceeds 30%, with a steep increase in patients >50 years of age. For example, nearly 75% of patients >80 years of age exhibit high blood pressure. Despite considerable evidence demonstrating the benefits of antihypertensive therapy, <50% are controlled. This chapter will discuss the prevalence and detection of high blood pressure, with a special emphasis on the role of hypertension in progressive renal fibrosis. The authors cover classification and epidemiology of blood pressure control; the pitfalls of blood pressure control, including white coat hypertension, pseudohypertension, nocturnal blood pressure, masked hypertension, isolated systolic hypertension, and blood pressure variability; hypertensive kidney disease; and clinical studies assessing the renal effects of hypertension, concluding with a discussion of control of blood pressure and CKD progression and future directions in research and therapy.