Hypertension in End-Stage Renal Disease

Abstract

Two distinct patterns of response of blood pressure to achievement of dry weight (no clinical evidence of edema and optimal body sodium content and volume of water), antihypertensive drugs and bilateral nephrectomy were documented in 40 unselected patients with end-stage renal disease. Group 1, 35 of 40 patients, was characterized by an excellent response of blood pressure to dry weight and the ability to remain normotensive without antihypertensive drugs as long as dry weight was maintained. Group 2, five of 40 patients, had persistent hypertension in spite of dry weight, a poor response to antihypertensive drugs and a prompt reduction of blood pressure after bilateral nephrectomy. A further important difference between these two groups was seen in the serum renin values obtained at the initiation of therapy. In Group 1 values ranged from 0 to 1.02 Goldblatt units × 10^–4 per milliliter of serum (mean, 0.31) whereas those in Group 2 ranged from 1.88 to 4.60 (mean of 3.37 units). Serum renin levels appear to be of value to predict blood-pressure response.