High-normal serum creatinine concentration is a predictor of cardiovascular risk in essential hypertension.

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Abstract
THE KIDNEY is a main target of organ damage in hypertension, and long-term exposure to elevations in blood pressure (BP), even within the normotensive range, can induce early renal damage.1 Current expert guidelines2,3 for the management of hypertension recommend determination of the serum creatinine concentration in all patients with hypertension as a marker of target organ damage. In the Joint National Committee VI guidelines,2 a frankly elevated creatinine concentration or the presence of proteinuria is considered a sign of organ damage, and a creatinine level of 106 to 178 µmol/L (1.2-2.0 mg/dL) is a major tool for risk stratification according to the World Health Organization–International Society of Hypertension guidelines.3 Nevertheless, few data exist about the prognostic value of normal or minimally elevated creatinine levels in hypertension. Despite the fact that renal hemodynamic values become abnormal even in the early stages of hypertension,4,5 the glomerular filtration rate is usually not significantly reduced until late in the course of the disease,6,7 and an elevated serum creatinine level is therefore a late sign of renal damage in essential hypertension. Although not an ideal marker for renal function,8 an increased serum creatinine level is strongly predictive of the subsequent development of end-stage renal disease.9 Moreover, frankly elevated serum creatinine values predict a poor prognosis in patients with hypertension,10-13 and mild elevations in serum creatinine levels were associated with an increased all-cause mortality rate in population-based samples of elderly patients14,15 and in patients with heart failure.16