Management of Renal Dysfunction

Management of hypertension in patients with kidney disease or diabetes is challenging, generally requiring 2-3 years of therapy to achieve the recommended blood pressure level. Studies have shown that some antihypertensive drugs can lower blood pressure without improving endothelial dysfunction and renal damage. For example, the traditional use of diuretics and a- and b-adrenoceptor blockers can lower blood pressure with no direct effect on endothelial dysfunction.53 ACE inhibitors, AT receptor blockers, and calcium channel blockers are the most effectively used treatment for hypertension as they lower blood pressure and improve endothelial dysfunction in hypertensive patients (Figure 6).

Aside from the classic treatment of hypertension, an emerging approach to renal dysfunction is the treatment of the components that trigger endothelial dysfunction, e.g., NO bioavailability and oxidative stress. For example, oral treatment with L-arginine, the precursor of NO, reduces blood pressure and improves endothelial dysfunction in hypertensive patients.60 Statins and lipid-lowering drugs improve endothelial dysfunction in hypertensive animal models by enhancing NO levels.61 Antioxidants also can improve endothelial dysfunction in hypertensive animal models. For example, the SOD mimetic tempol decreases hypertension and oxidation stress and improves endothelium-dependent relaxation and kidney damage in hypertensive animal models such as AT-II-infused mice and Dahl salt-sensitive rats.62

Reducing Blood Pressure Naturally

Reducing Blood Pressure Naturally

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