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Improved Renal Denervation Mitigated Hypertension Induced by Angiotensin II Infusion
Published on: May 26, 2022
Treatment of hypertension in patients with renal disease
1Rush University Hypertension/Clinical Research Center, Department of Preventive Medicine, Rush Presbyterian/St. Luke's Medical Center, Chicago, IL 60612, USA.
Insights
Managing hypertension in kidney disease requires multiple medications to reach blood pressure goals. Achieving these targets is crucial for kidney and cardiovascular health, yet many patients fall short, highlighting a need for improved treatment strategies.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Hypertension management in kidney disease is complex, often necessitating multiple antihypertensive agents.
- Current guidelines recommend strict blood pressure control (<130/85 mmHg for general kidney disease, <130/80 mmHg for diabetes) to reduce cardiovascular risk and preserve kidney function.
- Commonly prescribed combinations include ACE inhibitors or ARBs with diuretics, with beta-blockers or calcium channel blockers added as needed.
Purpose of the Study:
- To review current strategies for managing hypertension in patients with kidney disease.
- To emphasize the importance of achieving target blood pressure goals for renal and cardiovascular outcomes.
- To highlight the challenges in current treatment and the need for physician and patient education.
Main Methods:
- Review of current guidelines (JNC VI, WHO, National Kidney Foundation, American Diabetes Association).
- Discussion of commonly used antihypertensive drug classes and combinations (ACE inhibitors, ARBs, diuretics, beta-blockers, calcium antagonists).
- Analysis of recent data (NHANES III) on treatment goal achievement in hypertensive patients with diabetic kidney disease.
Main Results:
- Only 11% of patients with hypertension and diabetic kidney disease achieved the recommended blood pressure goal (<130/85 mmHg).
- The incidence of patients starting dialysis continues to increase, suggesting suboptimal management of hypertension in this population.
- Beta-blockers show promise in improving kidney function by reducing proteinuria and slowing decline.
Conclusions:
- Achieving target blood pressure in patients with kidney disease, especially with diabetes, remains a significant clinical challenge.
- Physicians must intensify efforts to manage hypertension effectively and educate patients on the critical importance of adhering to blood pressure guidelines.
- Optimizing antihypertensive therapy is essential to prevent progressive kidney damage and reduce cardiovascular events.
Abstract:
Management of hypertension in people with kidney disease is challenging and generally requires at least three different and complementary acting antihypertensive agents to achieve the recommended blood pressure goal by the JNC VI and WHO guidelines of <130/85 mmHg. This is also true for the recent blood pressure goal for diabetes of <130/80 mmHg recommended by both the National Kidney Foundation and American Diabetes Association for reduction of cardiovascular risk and preservation of kidney function. Commonly used combinations include an ACE inhibitor, which has compelling indications for use in people with kidney disease with a diuretic, generally a thiazide type agent. Angiotensin receptor blockers have clearly shown effectiveness for slowing nephropathy progression in Type 2 diabetes and clearly have a role as first-line agents in that disease. If additional therapy is required, either a beta blocker or calcium antagonist may be added to this antihypertensive 'cocktail'. Beta blockers are particularly effective in people with a high sympathetic drive, i.e. high pulse rates, to lower pressure and reduce cardiovascular risk. Moreover, in recent studies their benefits on kidney function both by reducing proteinuria and slowing decline of kidney function make them good agents to add in the appropriate clinical setting. Given recent data from an analysis of the NHANES III database showing only 11% of people being treated for hypertension with diabetic kidney disease have achieved the blood pressure goal of <130/85 mmHg, it's no wonder the incidence of people starting dialysis continues to climb. Physicians need to work harder and educate patients on the importance of achieving these lower blood pressure guidelines.
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