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Hypertension is a chronic condition in which the blood's force against artery walls is excessively high, posing risks such as heart disease. The condition's underlying mechanisms involve complex interactions among the cardiovascular, kidney, and autonomic nervous systems.Renin-Angiotensin-Aldosterone System (RAAS): This system significantly influences blood pressure regulation. When blood pressure decreases, the kidneys secrete renin. This enzyme transforms angiotensinogen, a plasma protein,...
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Hypertension in CKD: Core Curriculum 2019.

Elaine Ku1, Benjamin J Lee2, Jenny Wei3

  • 1Division of Nephrology and Pediatric Nephrology, Departments of Medicine and Pediatrics, University of California San Francisco, San Francisco, CA.

American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
|March 23, 2019
PubMed
Summary

Hypertension and chronic kidney disease (CKD) are linked, with each condition worsening the other. Managing blood pressure in CKD patients is crucial for reducing cardiovascular risks and mortality.

Keywords:
BP controlHypertensionambulatory blood pressure monitoring (ABPM)antihypertensive agentsblood pressure (BP)cardiovascular outcomeschronic kidney disease (CKD)renin-angiotensin system (RAS)review

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Area of Science:

  • Nephrology
  • Cardiology
  • Internal Medicine

Background:

  • Hypertension and chronic kidney disease (CKD) share complex pathophysiological links.
  • CKD progression can exacerbate blood pressure (BP) control issues.
  • Hypertension accelerates CKD progression and increases cardiovascular risks.

Purpose of the Study:

  • To review the pathophysiology of hypertension in CKD.
  • To outline current management strategies for hypertension in CKD patients.
  • To emphasize the importance of BP control in CKD for cardiovascular outcomes.

Main Methods:

  • Review of existing literature on hypertension and CKD.
  • Analysis of the multifactorial pathophysiology of hypertension in CKD.
  • Discussion of current treatment targets and therapeutic approaches.

Main Results:

  • Hypertension in CKD results from factors like reduced nephron mass, volume expansion, and hormonal activation.
  • Current treatment targets aim for clinic systolic BP < 130 mm Hg.
  • Key management strategies include salt restriction, ACE inhibitors/ARBs, and diuretics.

Conclusions:

  • Intensive BP control in CKD does not slow CKD progression but significantly reduces cardiovascular morbidity and mortality.
  • Effective hypertension management is vital for improving long-term outcomes in CKD patients.