Does treatment of hypertension prevent renal failure?

The association between malignant hypertension and renal insufficiency is now well established. The previous adage of not treating this entity for fear of precipitating renal failure has now been replaced by one of aggressive medical therapy as a means to prevent further renal damage. Even when treatment appears to cause renal insufficiency, continued aggressive therapy is indicated as the majority of these people will either stabilize or even improve their renal function. The association of renal failure and benign hypertension is less clear. We feel that if long-term controlled studies could be performed, benefit would be evident. However, even without this evidence, the ability to prevent the malignant hypertensive lesion is sufficient reason to aggressively treat this group.