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Pharmacotherapy of hypertension in patients with pre-dialysis chronic kidney disease
Charalampos Loutradis1, Pantelis Sarafidis1
1Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki , Thessaloniki, Greece.
Insights
Managing hypertension in chronic kidney disease (CKD) involves lowering blood pressure (BP) and proteinuria. Strict BP control below 130/80 mmHg is recommended to reduce CKD progression and cardiovascular disease risks.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Hypertension is a prevalent comorbidity in chronic kidney disease (CKD) patients, affecting up to 90% of end-stage renal disease (ESRD) cases.
- Blood pressure (BP) elevation in CKD is multifactorial, necessitating tailored therapeutic interventions.
Purpose of the Study:
- To review current data on hypertension management in CKD patients.
- To discuss optimal BP targets and the role of major antihypertensive drug classes.
Main Methods:
- Systematic review of existing literature on hypertension in CKD.
- Analysis of data regarding BP targets and antihypertensive agent efficacy.
Main Results:
- Aggressive BP control to <130/80 mmHg is proposed for proteinuric nephropathies.
- Recent studies support strict BP control for reduced renal and cardiovascular outcomes.
- International guidelines increasingly recommend these BP goals for hypertensive CKD patients.
Conclusions:
- Hypertension management in CKD necessitates BP lowering and proteinuria reduction to prevent CKD progression and cardiovascular disease.
- Renin-angiotensin system (RAS) blockers are preferred for proteinuric nephropathies.
- Combination therapy with multiple antihypertensive agents is often required for BP control in CKD.
Introduction:
Hypertension is the most common co-morbidity in patients with chronic kidney disease (CKD), with prevalence gradually increasing across CKD Stages to the extent that about 90% of end-stage renal disease (ESRD) patients are hypertensives. Several factors contribute to blood pressure (BP) elevation and guide the therapeutic interventions that should be employed in these patients.
Areas Covered:
This review summarizes the existing data for the management of hypertension, regarding optimal BP targets and the use of major antihypertensive classes in patients with CKD.
Expert Opinion:
Management of hypertension in CKD requires both lowering BP levels and reducing proteinuria to minimize the risk of both CKD progression and cardiovascular disease. In this respect, aggressive control of office BP to levels <130/80 mmHg has long been proposed for patients with proteinuric nephropathies. Following evidence from recent studies that confirmed significant reductions in renal and cardiovascular outcomes with strict BP control, most, but not all, of international guidelines, suggest such BP goals for all hypertensive patients, including those with CKD. Use of renin-angiotensin system (RAS) blockers is the treatment of choice for patients with proteinuric nephropathies, while, in most patients with CKD, combination treatment with two, three, or more antihypertensive agents is often required to control BP.
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