Purpose of review 

Treating mild-to-moderate essential hypertension in nondiabetic African Americans fails to halt nephropathy progression, whereas hypertension control slows nephropathy progression in European Americans. The pathogenesis of these disparate renal syndromes is reviewed.

Recent findings 

The nonmuscle myosin heavy chain 9 gene (MYH9) is associated with a spectrum of kidney diseases in African Americans, including idiopathic focal global glomerulosclerosis historically attributed to hypertension, idiopathic focal segmental glomerulosclerosis, and the collapsing variant of focal segmental glomerulosclerosis [HIV-associated nephropathy (HIVAN)]. Risk variants in MYH9 likely contribute to the failure of hypertension control to slow progressive kidney disease in nondiabetic African Americans.

Summary 

Early and intensive hypertension control fails to halt progression of ‘hypertensive nephropathy’ in African Americans. Genetic analyses in patients with essential hypertension and nephropathy attributed to hypertension, focal segmental glomerulosclerosis and HIVAN reveal that MYH9 gene polymorphisms are associated with a spectrum of kidney diseases in this ethnic group. Mild to moderate hypertension may cause nephropathy in European Americans with intrarenal vascular disease improved by the treatment of hypertension, hyperlipidemia and smoking cessation.