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Hypertension and the kidneys

Áine M De Bhailis1, Philip A Kalra1

  • 1Department of Nephrology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK.

British Journal of Hospital Medicine (London, England : 2005)
|June 2, 2022
PubMed

Insights

Hypertension significantly impacts cardiovascular health and mortality, especially in patients with chronic kidney disease. Managing blood pressure is crucial for slowing kidney disease progression and reducing cardiovascular risks.

Area of Science:

  • Nephrology
  • Cardiology
  • Internal Medicine

Background:

  • Hypertension is a primary global risk factor for cardiovascular disease and mortality.
  • Hypertension and chronic kidney disease (CKD) share a complex bidirectional relationship, where each condition exacerbates the other.
  • CKD complicates hypertension management due to factors like sodium retention, sympathetic nervous system activation, and hormonal imbalances.

Purpose of the Study:

  • To review the complex pathophysiological mechanisms of hypertension in the context of CKD.
  • To explore the interplay between hypertension, CKD, and renovascular disease.
  • To discuss current treatment strategies, blood pressure targets, and cardiovascular benefits of optimal control.

Main Methods:

  • This review synthesizes existing literature on hypertension pathophysiology in CKD.
  • It examines the roles of the sympathetic nervous system, renin-angiotensin-aldosterone system, and sodium balance.
  • The review also covers renovascular disease and therapeutic interventions.

Main Results:

  • Hypertension in CKD involves multiple interacting factors, including nephron loss and hormonal dysregulation.
  • Poorly controlled hypertension accelerates CKD progression towards end-stage kidney disease.
  • Renovascular disease is a key consideration for both cause and treatment.

Conclusions:

  • Understanding the multifaceted pathophysiology of hypertension in CKD is essential for effective management.
  • Optimal blood pressure control offers significant long-term cardiovascular benefits and slows CKD progression.
  • Targeted therapeutic interventions, including addressing renovascular disease, are vital for improving patient outcomes.

Keywords:
Cardiovascular diseaseChronic kidney diseaseEnd-stage kidney diseaseHypertension

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