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Influence of antihypertensive therapy on renal function

  • Carvedilol and The Kidney
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Summary

Antihypertensive therapy influences kidney function by different mechanisms depending on the mode of action of the drug used. The GFR is improved by calcium entry blockers and ACE inhibitors, unaffected by vasodilators, α-blockers and centrally acting sympatholytics and impaired by β-blockers. The same is true for renal blood flow and is due to changes of renal vascular resistance. Renal sodium excretion is impaired mostly by vasodilators, by α-blockers, sympatholytics and β-blockers; in contrast, calcium entry blockers and ACE inhibitors acutely induce natriuresis. The RAAS is stimulated by vasodilators, unaffected by α-blockers and sympatholytics and suppressed by β-blockers. Plasma catecholamines are stimulated by vasodilators and suppressed by centrally acting sympatholytics and unaffected by the others. Induction of acute renal functional impairment is reported for ACE inhibitors under conditions of compromised renal perfusion pressure such as in renal artery stenosis. These data from the literature reviewed are supported by our own experimental data on sodium balance under different drugs and micropuncture data in experimental renal artery stenosis. To achieve effective antihypertensive treatment with a low profile of side effects, careful monitoring of renal function seems to be mandatory.

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Abbreviations

ACE:

angiotensin-converting enzyme

RAAS:

renin-angiotensin-aldosterone system

GFR:

glomerular filtration rate

SHR:

spontaneously hypertensive rats

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Authors and Affiliations

  1. Department of Nephrology, Medizinische Hochschule Hannover, Germany

    U. Frei, R. Schindler & K. M. Koch

  2. Department of Nephrology, Medizinische Hochschule Hannover, Konstanty-Gutschow-Strasse 8, W-3000, Hannover 61, Germany

    U. Frei

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Frei, U., Schindler, R. & Koch, K.M. Influence of antihypertensive therapy on renal function. Clin Investig 70 (Suppl 2), S120–S126 (1992). https://doi.org/10.1007/BF00207622

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