Which antihypertensive drugs are the most nephroprotective and why?

Paolo Cravedi, Piero Ruggenenti, Giuseppe Remuzzi

Research output: Contribution to journalReview articlepeer-review

22 Scopus citations


Importance of the field: Hypertension is a major independent risk factor for kidney disease and for faster renal function loss. Choice of antihypertensive strategies with highest nephroprotective effect is crucial to prevent or reverse progression to end stage renal disease (ESRD). Areas covered in this review: The present review focuses on the role of hypertension in the progression of chronic kidney disease (CKD), the renoprotective effects of different antihypertensive therapies, and the blood pressure levels that should be targeted in different patient populations. To this end, the PubMed (1975 2010) database was searched for English-language articles, using the following keywords: hypertension, kidney disease, ACE-inhibitor, angiotensin receptor blocker, aldosterone antagonist, renin inhibitor, proteinuria. What the reader will gain: A comprehensive review of data on the association between hypertension and progression of chronic nephropathies and on the antihypertensive treatments with highest nephroprotective effects. Take home message: Blood pressure should be targeted to 140/90 mmHg or less in patients with hypertension but no renal injury and 130/80 mmHg or less in those with CKD. Amongst different antihypertensive drugs, renin angiotensin aldosterone system (RAAS) inhibitors have an incremental nephroprotective effect in proteinuric patients. Maximal RAAS inhibition should be aimed to optimize renoprotection in hypertensive patients with CKD and proteinuria.

Original languageEnglish
Pages (from-to)2651-2663
Number of pages13
JournalExpert Opinion on Pharmacotherapy
Issue number16
StatePublished - Nov 2010
Externally publishedYes


  • ACE inhibitor
  • Angiotensin receptor blocker
  • Chronic kidney disease
  • Hypertension
  • Proteinuria


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