Renal protection: are all antihypertensive drugs comparable?

Chronic kidney disease, stage 3 or higher, affects approximately 20 million people in the United States. Aggressive management of blood pressure is critical to slow the decline in renal function. Despite adequate control, however, patients continue to progress to end-stage renal disease. A surrogate marker for renal parenchymal injury is the presence of proteinuria. Blood pressure reduction per se has been shown to decrease proteinuria. However, certain classes of antihypertensive agents, namely the inhibitors of the renin-angiotensin-aldosterone system, exert antiproteinuric and renoprotective effects that are in addition to, but independent of, blood pressure lowering. This article reviews the beneficial renoprotective effects of various classes of antihypertensive agents in chronic kidney disease.