Significance of the nephroprotective effect of sartan in the treatment of hypertension

Abstract

Arterial hypertension can be both a cause and a consequence of renal dysfunction. Assessment of the existence of impaired renal function, determination of serum creatinine and urate, as well as the ratio of albumin and creatinine in urine, is an integral part of the diagnostic algorithm for patients with arterial hypertension. The main postulates for the treatment of hypertension in patients with renal dysfunction, regardless of the presence of diabetes mellitus, include good control of blood pressure and reduction of proteinuria. Attenuation of the renin-angiotensin-aldosterone system by angiotensin-converting enzyme inhibitors and angiotensin II receptor type 1 blockers (sartans) slows renal impairment in diabetic and hypertensive nephropathy. However, their simultaneous use is contraindicated, because it does not lead to a reduction in cardiovascular mortality and morbidity, and increases the risk of hypotension, hyperkalemia and adverse renal outcomes. In this review article, we summarize in a practical way the most important aspects of early detection and treatment of renal damage in patients with hypertension, with special emphasis on the importance of nephroprotective effects of sartan.