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Management of hypertension in advanced kidney disease

Panagiotis I Georgianos1, Rajiv Agarwal2

  • 1Section of Nephrology and Hypertension, 1st Department of Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

Current Opinion in Nephrology and Hypertension
|June 21, 2022
PubMed

Insights

Newer therapies improve hypertension management in advanced chronic kidney disease (CKD). Potassium binders aid spironolactone use, novel nonsteroidal mineralocorticoid receptor antagonists (MRAs) show promise, and chlorthalidone effectively lowers blood pressure.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Hypertension is a significant complication in patients with advanced chronic kidney disease (CKD).
  • Managing blood pressure in CKD patients is challenging due to risks of hyperkalemia and reduced drug efficacy.

Purpose of the Study:

  • To review recent advancements in pharmacotherapy for hypertension in patients with advanced CKD.
  • To highlight novel therapeutic strategies for improved blood pressure control in this high-risk population.

Main Methods:

  • Review of recent clinical trials including AMBER, BLOCK-CKD, and CLICK.
  • Analysis of pharmacologic interventions targeting blood pressure and potassium levels in CKD patients.

Main Results:

  • Patiromer, a potassium binder, facilitated spironolactone use and improved blood pressure control in patients with resistant hypertension and advanced CKD.
  • The novel nonsteroidal mineralocorticoid receptor antagonist (MRA) KBP-5074 demonstrated significant blood pressure reduction with minimal hyperkalemia risk in advanced CKD.
  • Chlorthalidone, a thiazide-like diuretic, effectively lowered 24-hour ambulatory systolic blood pressure in patients with stage 4 CKD and uncontrolled hypertension.

Conclusions:

  • New potassium-binding agents enable more consistent spironolactone therapy.
  • Novel nonsteroidal MRAs offer a potentially improved benefit-risk profile for hypertension management in advanced CKD.
  • Chlorthalidone presents a viable option for blood pressure reduction in high-risk CKD patients.
Abstract

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