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The prevalence of hypertension is increasing relentless as the population becomes more obese and older. Hypertension has long been known to worsen the outcomes of many common conditions including heart failure, stroke, dementia and chronic kidney disease but the role of the kidney is of unique importance.Thus, hypertensive nephropathy impairs the ability of the kidneys to rapidly and accurately adjust salt and water excretion to match the levels of intake, thereby accounting for the high prevalence of salt sensitive hypertension in patients with CKD. This can evolve into a vicious cycle whereby increasing hypertension leads to increasing kidney damage that exacerbates the hypertension.
Unfortunately, current drug therapy is generally disappointing in slowing the progress of hypertensive nephrosclerosis until the patients develop overt proteinuria when renin-angiotensin-aldosterone system （RAAS） inhibitors begin to be effective.Accordingly, most patients progress, albeit slowly, to end-stage renal disease. Clearly,there is an urgent need for a better scientific understanding of the causes of hypertensive nephropathy.
Research in hypertensive nephropathy has progressed slowly until recently. This has been an important failing since, without a better understanding of its causes, it is hard to prevent the adverse consequences of hypertensive nephropathy for the cardiovascular system and the brain. There are a number of controllable factors that underlie the development and severity of hypertension that include a healthy diet, regular aerobic exercise, control of body weight, limitation of alcohol intake, reduction in air pollution and moderation of stress. There remain a number of factors that presently are not modifiable that include sex, age, and genetic predisposition. However, with the rapidly growing science of cellular senescence, gene polymorphism and epigenetics even these factors may become modifiable, at least to a degree.
The way forward towards a comprehensive approach to hypertension and hypertensive nephropathy must start with secure scientific discoveries. These almost always emanate from basic laboratory research focused on problems identified by clinical practitioners. The special challenges of nephrosclerosis include the causes of microalbuminuria, glomerular sclerosis and renal fibrosis. The validity of any basic research finding then requires rigorous testing by properly blinded, large-scale randomized, controlled clinical trials. Great strides are being made currently in China and elsewhere towards achieving these goals. It is almost 50 years since the introduction of RAAS blockers and even longer since the first use of diuretics to treat hypertension.These have been extraordinarily important advances for patients with hypertension, yet provide only a partial solution to the problem of hypertensive nephrosclerosis.
“Hypertensive Nephropathy” is a timely opportunity for clinicians, scientists and students to evaluate our present understanding of this very difficult, but increasingly important problem and to ponder the way ahead. It provides a series of insights by acclaimed experts in molecular biology, physiology, cardiology, nephrology and pharmacology. The topics selected cover not only the traditional and new viewpoints on the pathogenesis of hypertensive nephropathy but also delve deeply into the basic and clinical research that forms the basis of our current guidelines for diagnosis,prevention and treatment. This frames an overview of the current state of the science and clinical practice of hypertensive nephropathy. The book is designed to provide a focused source of information for cardiologists, nephrologists, general physicians and clinicians, scientists and healthcare professionals and importantly for the many students and postdoctoral researchers who wish to broaden their understanding of this evolving field.
Christophers. Wilcox, M.D., Ph.D., F.R.C.P. （U.K.）, F.A.C.P.
Walters Family Chair of Cardiovascular Research
Professor of Nephrology
Director, Hypertension Center
Georgetown University
Washington, D.C.