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March 22, 1976

Hypertension and Renal Disease-Reply

Author Affiliations

University of Southern California School of Medicine Los Angeles

JAMA. 1976;235(12):1212. doi:10.1001/jama.1976.03260380016014

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In Reply.—  At least four of the six references cited by Dr Rubinoff relate to malignant nephrosclerosis. This is an acute entity that, if not arrested, leads to irreversible renal disease, and vigorous treatment is indicated. Our article states this clearly.In regard to chronic renal failure as the result of benign nephrosclerosis, there is no evidence that long-term "vigorous" treatment of hypertension reverses or even prevents progression of this. Nevertheless, we treat such patients, but at least initially, we do not lower the diastolic pressure below 100 to 105 mm Hg. This allows for hemodynamic adjustments and tends to minimize the chances of clinical uremia developing. More vigorous treatment, on a long-term basis, is left to the judgement of the physician and the tolerance of treatment by the patient.