From the Guidelines
A patient diagnosed with untreated systemic hypertension at age 20 is likely to develop chronic kidney disease (CKD) within 15-20 years, typically by their mid-30s to early 40s. The progression from hypertension to CKD is variable and depends on several factors including blood pressure control, genetic predisposition, and presence of other risk factors 1. Untreated hypertension damages kidneys through increased pressure in the glomeruli, causing scarring and reduced filtering capacity over time. This damage occurs gradually but continuously when blood pressure remains elevated. The risk is particularly high in patients with systolic blood pressure above 160 mmHg or diastolic above 100 mmHg.
Some key points to consider in the management of hypertension to prevent CKD include:
- Routine screening for hypertension is crucial, especially in younger patients, as up to 33% of men aged 20 to 44 years with hypertension may be unaware of their condition 1.
- In African American persons, hypertension develops at a younger age and may present with a higher prevalence of complications at the time of diagnosis, including stroke and end-stage kidney disease, compared with other ethnic groups 1.
- Recognition, diagnosis, education, and effective management are critical to reduce the long-term morbidity and mortality associated with hypertension.
To prevent the progression to CKD, immediate treatment with antihypertensive medications such as ACE inhibitors (like lisinopril 10-40 mg daily) or ARBs (such as losartan 50-100 mg daily) is recommended, as these medications specifically protect kidney function while controlling blood pressure. Regular monitoring of kidney function through annual creatinine and urine albumin tests is essential, and blood pressure should be maintained below 130/80 mmHg to minimize kidney damage.
From the Research
Untreated Systemic Hypertension and Chronic Kidney Disease
- Untreated systemic hypertension can lead to the development of chronic kidney disease (CKD) due to the increased blood pressure causing damage to the kidneys 2.
- The risk of developing CKD is higher in patients with hypertension, and the risk increases with the duration and severity of the hypertension 2.
- Studies have shown that tight blood pressure control can reduce the risk of developing CKD and slow the progression of renal disease in patients with hypertension 2, 3.
Age of Onset of Chronic Kidney Disease
- The age of onset of CKD in patients with untreated systemic hypertension is not explicitly stated in the provided studies.
- However, it is known that the risk of developing CKD increases with age, and patients with hypertension are at a higher risk of developing CKD at a younger age 2.
- A study published in 2006 found that hypertension affects 25% of the adult population in the United States, and the incidence of CKD and end-stage renal disease (ESRD) is increasing due to the increasing age of the population and the rise in risk factors, including hypertension 2.
Progression of Renal Disease
- The progression of renal disease in patients with untreated systemic hypertension can be slowed down with tight blood pressure control and the use of certain antihypertensive medications, such as angiotensin-converting enzyme (ACE) inhibitors and calcium channel blockers (CCBs) 3, 4, 5.
- A study published in 2016 found that the combination of a CCB and an ACE inhibitor or angiotensin II receptor blocker (ARB) can be a preferable antihypertensive therapy in patients with CKD, considering their higher effect in decreasing blood pressure and fewer adverse metabolic problems caused 4.
- Another study published in 1996 found that CCBs that maintain reductions in proteinuria can slow the progression of nephropathy associated with non-insulin dependent diabetes mellitus (NIDDM) by a degree comparable to ACE inhibitors, given similar levels of blood pressure control 5.