26th June 2023

Renal hypertension

Hypertension secondary to renal disease itself can be caused by conditions such as renal artery stenosis, chronic glomerulonephritis, bilateral reflux nephropathy or polycystic disease. There are two main mechanisms which are responsible for the increase in blood pressure:

1.   Activation of the renin-angiotensin-aldosterone (RAAS) system
2.   Retention of salt and water

If the renal disease in question is cortical in nature, such as in glomerulonephritis, hypertension occurs earlier, is more common, and tends to be more severe. This leads to an increase in blood volume and therefore blood pressure. Tight control of blood pressure is necessary to prevent further deterioration in renal function, and there is good evidence that ACE inhibitor treatment offers significant renal protection.