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Annals of Internal Medicine tip sheet for April 1, 2008, issue
Date:3/31/2008

conditions, health insurance should pay for long-term behavioral and pharmacotherapy (Perspective, p. 554).

3. Early Kidney Dysfunction Associated with Developing Hypertension

Most people with kidney disease have hypertension, but which comes first? Does kidney disease lead to hypertension, or does hypertension start the process that leads to kidney disease? A study of 2,767 people without kidney disease or hypertension in the Multi-Ethnic Study of Atherosclerosis found that about 20 percent who were initially free of hypertension developed the disease later on (Article, p. 501).

Serum cystatin C levels and urinary albumin excretion -- the most sensitive indicators of kidney dysfunction -- were associated with a statistically significant 15 percent greater incidence of hypertension. Apparently, early kidney damage triggers hypertension, rather than the other way around.


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Contact: Susan Anderson
sanderson@acponline.org
215-351-2655
American College of Physicians
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