Hypertension in Chronic Kidney Disease: An Update on Diagnosis and Management

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Hypertension (HTN) and chronic kidney disease (CKD) share a complex pathophysiologic relationship.
• Long-term HTN can impair kidney function, while declining renal function exacerbates blood pressure (BP) control.
• HTN in CKD arises from factors like salt/water retention, volume expansion, sympathetic overactivity, RAAS activation, and endothelial dysfunction.

Approach:

• This review synthesizes current evidence and clinical recommendations for managing HTN in CKD.
• It details the pathophysiology, diagnosis, and management strategies for HTN within the CKD population.
• Special attention is given to unique considerations in special populations with CKD.

Key Points:

• Significant blood pressure variability is a hallmark of CKD, necessitating vigilant monitoring.
• The diagnosis and management of HTN in CKD have evolved considerably over the past decade.
• Understanding the interplay of contributing factors is crucial for effective BP management.

Conclusions:

• Effective management of HTN in CKD requires a comprehensive approach addressing its multifaceted pathophysiology.
• Close monitoring of BP variability is essential for optimizing treatment strategies.
• This review provides an updated framework for clinicians managing HTN in CKD patients, including special populations.