Hypertension in autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease is the most common inherited kidney disease, characterized by gradual and progressive cyst growth and renal enlargement, resulting in a decline in kidney function and the development of renal failure. Hypertension is common and occurs early, prior to the loss of renal function, with 29 years being the mean age of diagnosis. The pathophysiology of hypertension is multifactorial and is characterized by hyperactivity of the renin–angiotensin–aldosterone system, activation of the sympathetic nervous system and endothelial dysfunction. Early antihypertensive therapy appears to postpone the development of renal failure and cardiovascular events in this disorder. This chapter reviews the epidemiology, pathophysiology and management of hypertension in autosomal dominant polycystic kidney disease.