Resistant Hypertension in People With CKD: A Review

Area of Science:

• Nephrology
• Cardiology
• Hypertension Management

Background:

• Resistant hypertension is prevalent in chronic kidney disease (CKD) patients.
• It significantly elevates risks for cardiovascular events and kidney failure.
• Recent guidelines differentiate true from pseudo-resistant hypertension.

Purpose of the Study:

• To review the distinction between true and pseudo-resistant hypertension for nephrologists.
• To guide the evaluation and management of resistant hypertension in CKD.
• To incorporate recent evidence on treatment strategies and device therapies.

Main Methods:

• Review of the latest American College of Cardiology/American Heart Association scientific statement.
• Discussion of diagnostic evaluation for secondary hypertension.
• Examination of medication optimization, lifestyle modifications, and mineralocorticoid receptor antagonists.
• Emphasis on diuretic use in CKD patients.
• Overview of antihypertensive device therapies.

Main Results:

• The distinction between true and pseudo-resistant hypertension is crucial for appropriate patient management.
• Secondary hypertension evaluation is essential.
• Medication adherence, lifestyle changes, and specific drug classes like diuretics and mineralocorticoid receptor antagonists are key.
• Device therapies offer future potential.

Conclusions:

• Accurate diagnosis and tailored management are vital for resistant hypertension in CKD.
• Nephrologists play a critical role in optimizing therapy.
• A proposed algorithm aids in diagnosis and management.
• Emerging device therapies warrant further investigation.