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The kidney and hypertension: causes and treatment

Domenic A Sica1

  • 1Section of Clinical Pharmacology and Hypertension, Division of Nephrology, Virginia Commonwealth University Health System, Richmond, VA 23298-0160, USA. dsica@mcvh-vcu.edu

Journal of Clinical Hypertension (Greenwich, Conn.)
|July 9, 2008
PubMed

Insights

Hypertension in chronic kidney disease (CKD) is often driven by extracellular volume expansion. Treatment requires multiple antihypertensive drug classes, including diuretics, with lower blood pressure goals than essential hypertension.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Research

Background:

  • Chronic kidney disease (CKD) is intricately linked with hypertension, acting as both a cause and a consequence.
  • Extracellular volume expansion is a primary driver of hypertension in CKD patients.

Purpose of the Study:

  • To analyze the characteristics and management of hypertension in the context of CKD.
  • To provide guidance on antihypertensive medication sequencing and blood pressure targets for CKD patients.

Main Methods:

  • Review of existing literature on CKD and hypertension.
  • Analysis of physiological factors contributing to hypertension in CKD.
  • Evaluation of current treatment guidelines and prescription practices.

Main Results:

  • Hypertension in CKD lacks distinct characteristics beyond volume expansion, making medication sequencing often arbitrary.
  • Effective management necessitates multiple antihypertensive drug classes, with diuretics being crucial.
  • Blood pressure targets for CKD patients are generally lower than for those with essential hypertension.

Conclusions:

  • Treatment strategies for hypertension in CKD should prioritize volume management and combination therapy.
  • Further research is needed to establish optimal blood pressure lowering targets in CKD.

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