Management of hypertension in CKD: beyond the guidelines

Area of Science:

• Nephrology
• Cardiology
• Pharmacology

Background:

• Hypertension and chronic kidney disease (CKD) share a bidirectional relationship, where declining kidney function elevates blood pressure (BP), and sustained high BP accelerates kidney disease progression.
• CKD often impairs the kidneys' ability to excrete salt, leading to salt sensitivity and complicating hypertension management.

Purpose of the Study:

• To review current management strategies for hypertension in patients with CKD.
• To discuss challenges including altered BP circadian rhythms, medication dosing, BP targets, and secondary hypertension evaluation.

Main Methods:

• Review of current literature and clinical practice guidelines regarding hypertension management in CKD.
• Focus on the interplay between salt handling, BP control, and therapeutic interventions.

Main Results:

• Salt sensitivity is a key factor in hypertension management for CKD patients.
• Established treatments include ACE inhibitors or ARBs, alongside dietary salt restriction and diuretics.
• Altered circadian BP rhythms are common, with potential benefits from bedtime medication dosing.

Conclusions:

• Effective hypertension management in CKD necessitates addressing salt sensitivity through diet and medication.
• Optimizing antihypertensive medication timing, particularly bedtime dosing, may be crucial for restoring normal BP circadian patterns and improving outcomes.