New European guidelines for management of hypertension: what is relevant for the nephrologist.

It is well established among nephrologists that advanced renal failure is associated with an increased prevalence of cardiovascular (CV) disease including myocardial infarction, stroke and heart failure [1]. Recently, a great amount of information has become available, which demonstrates that the finding of minor abnormalities of renal function also predicts more CV risk in the general population, as well as in hypertensive patients [2]. Recently, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) have published their guidelines for the management of arterial hypertension [3]. This came only a short time after the JNC 7 report had been published [4]. Some of the relevant changes refer to the introduction of new risk factors that have come to complete the list of major CV risk factors. In this sense, both guidelines recognize the relevance of minor abnormalities of renal function, easily detectable by practicing physicians, for the stratification of patients with arterial hypertension. The Seventh Report of the Joint National Committee [4] considers the findings of microalbuminuria or diminished estimated level of glomerular filtration rate (eGFR) (<60ml/min) as major CV risk factors. These also include hypertension, cigarette smoking, obesity, physical inactivity, dyslipidaemia, diabetes mellitus, age >55 years in men and 65 years in women, and a family history of premature CV disease. Similarly the ESH/ESC guidelines [3] contemplate among the factors influencing prognosis in hypertensive patients the finding of a slight elevation in serum creatinine (>1.3mg/dl in men and 1.2mg/dl in women) and/or microalbuminuria. The presence of chronic kidney disease, defined in ESH/ESC guidelines as serum creatinine values >1.5mg/dl in men and 1.4mg/dl in women or by the presence of proteinuria (>300mg/day), is also considered as a CV risk factor. The ESH/ESC guidelines also recommend to estimate either the creatinine clearance (using the Cockroft– Gault formula) or the glomerular filtration rate [eGFR—using the modified Modification of Diet in Renal Disease (MDRD) formula] [3].