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[Management of hypertension in CKD patients]
Tetsuro Kusaba1, Kenjiro Kimura
1Division of Nephrology, Nantan General Hospital.
Insights
Effective blood pressure control is crucial for chronic kidney disease (CKD) patients to preserve kidney function and prevent cardiovascular disease (CVD). Renin-angiotensin system inhibitors are recommended for CKD patients to manage hypertension and reduce proteinuria.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Management
Context:
- Chronic kidney disease (CKD) patients often exhibit non-dipper and salt-sensitive hypertension, significant risk factors for both CKD progression and cardiovascular disease (CVD).
- Clinical evidence underscores the necessity of stringent blood pressure control in mitigating CKD advancement and CVD incidence.
Purpose:
- To outline the therapeutic goals for managing hypertension in CKD patients, focusing on renal function preservation and CVD prevention.
- To establish target blood pressure guidelines based on proteinuria levels for CKD management.
- To highlight the efficacy of renin-angiotensin system (RAS) inhibitors in managing hypertension and proteinuria in CKD.
Summary:
- Target blood pressure for CKD patients is <130/80 mmHg with proteinuria <1 g/day and 125/75 mmHg with proteinuria >1 g/day.
- Renin-angiotensin system (RAS) inhibitors, including angiotensin receptor blockers (ARBs) and ACE inhibitors (ACEIs), demonstrate superior efficacy in reducing proteinuria and preserving renal function compared to other antihypertensive agents.
- RAS inhibitors should be a primary treatment for CKD-related hypertension unless contraindicated by hyperkalemia or significant increases in serum creatinine. Additional antihypertensive agents may be required for resistant hypertension.
Impact:
- Optimized blood pressure management in CKD patients can significantly slow disease progression and reduce the risk of cardiovascular complications.
- The use of RAS inhibitors offers a targeted approach to managing proteinuria and preserving kidney function in CKD.
- This strategy aims to improve long-term outcomes and quality of life for individuals with chronic kidney disease.
Abstract:
The purpose of treatment for chronic kidney disease (CKD) is to preserve the renal function and to prevent the cardiovascular disease (CVD). CKD patients frequently present non-dipper and salt-sensitive type hypertension, which is a powerful predictor for both the CKD and CVD. Many previous clinical studies in CKD patients showed that appropriate blood pressure control was absolutely necessary to prevent the progression of CKD and development of CVD. From these studies, the target blood pressure for CKD patients is determined as less than 130/80 mmHg, if amount of urinary protein < 1 g/day, and 125/75 mmHg, if urinary protein > 1 g/day. Especially, blood pressure control using the RAS (renin-angiotensin system) inhibitor such as ARBs or ACEIs is superior to other classes of antihypertensive agents in reducing the amount of urinary protein and in preserving renal function. Thus, ARBs and/or ACEIs should be administered to CKD patients unless hyperkalemia or excessive increase in serum creatinine level is observed. Furthermore, hypertension in CKD patients is sometimes intractable and other classes of antihypertensive agents should be administered in addition to ARBs or ACEIs to obtain the target blood pressure.
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