[Vascular impact of anti-hypertensive treatment and renal protection].

Hypertension contributes to the progression of renal disease by accelerating structural changes in the kidney, leading to a progressive decline in glomerular filtration rate. Hypertension and microvascular changes can create a vicious circle, leading to further renal damage and increases in blood pressure. Prevention of renal damage is a priority, especially in the growing number of patients with diabetic hypertension. Angiotensin receptor blocking drugs and ACE inhibitors have been shown to display renoprotective effects, and ACE inhibitors reduce the risk of microalbuminuria, the initial step in renal disease in diabetes. Impressive results have been obtained with a low-dose combination of the ACE-inhibitor perindopril and the diuretic indapamide, which not only gave superior reductions in blood pressure to enalapril, but also a 24% greater reduction in albumin excretion. Perindopril/indapamide also showed a trend towards reducing cardiovascular events. There is evidence from animal studies that this combination protects both renal structure and function.