Renal effects of antihypertensive agents in parenchymal renal disease and renovascular hypertension.

Treatment of hypertension by conventional antihypertensive medications usually has no significant effect on renal function in patients with essential hypertension and normal glomerular filtration rate. In this condition, new agents such as angiotensin-converting enzyme (ACE) inhibitors and calcium-channel blockers (CCBs) also do not appear to modify renal function. Reduction of arterial pressure is crucial for renal protection in patients with chronic renal disease and the effect of the new agents on the progression of renal failure remains unknown despite some promising reports. In patients with renovascular hypertension, mainly those with bilateral stenosis or stenosis of a solitary kidney, the use of ACE inhibitors may be associated with reversible renal deterioration, particularly in subjects with already impaired renal function and receiving diuretics. In this situation, reduction in arterial pressure by CCBs does not appear to lead to renal deterioration.