ABSTRACT
INTRODUCTION A large amount of clinical and epidemiologic evidence has been accumulated in support of the importance of blood pressure (BP) control to reduce chronic kidney disease (CKD) progression. It is also generally accepted that suppression of the renin-angiotensin-aldosterone system (RAAS) must be considered in any patient with CKD, in particular if albuminuria is present. However, the analysis of renal outcome through the estimation of glomerular filtration rate (GFR) in trials primarily devoted to cardiovascular (CV) protection in hypertensive patients, in particular the Antihypertensive and Lipid-Lowering treatment to prevent Heart Attack Trial (ALLHAT), has come to question the superiority of the suppression of the RAAS over BP control to protect the kidneys in hypertensive patients (1). The topic is particularly interesting because the existence of an increased CV risk associated with renal function decline has been amply demonstrated in many different clinical situations, including arterial hypertension. The enhancement in global CV risk accompanying CKD would force the need to use drugs suppressing the RAAS for CV protection independent of the influence on renal outcome (2).
