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Revisiting resistant hypertension in kidney disease
1Division of Nephrology, University of Texas Health San Antonio, San Antonio, Texas, USA.
Current Opinion in Nephrology and Hypertension
|May 10, 2024
Summary
Resistant hypertension in chronic kidney disease (CKD) patients increases healthcare burden. Optimizing diuretics and sodium restriction are key, with new treatments emerging for this complex condition.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Resistant hypertension (RH) significantly increases healthcare burden and end-organ damage in chronic kidney disease (CKD) patients.
- CKD patients have a 2-3x higher risk of developing RH compared to the general population.
- Distinguishing true RH from apparent treatment-resistant hypertension (aTRH) is crucial but challenging.
Purpose of the Study:
- To review the latest findings in pathophysiology, definition, identification, and treatment strategies for RH in CKD.
- To determine the impact of updated blood pressure (BP) guidelines (e.g., <130/80 mmHg) on RH prevalence in CKD.
- To highlight the challenges and future directions in managing RH in CKD.
Main Methods:
- Literature review of recent studies on RH in CKD.
- Analysis of current guidelines and their impact on BP targets.
- Discussion of pathophysiological mechanisms, including sodium retention.
Main Results:
- Up to 50% of CKD patients may meet aTRH criteria under current BP guidelines (<130/80 mmHg).
- Excess sodium retention is a primary driver of treatment resistance in CKD.
- Optimizing diuretic regimens and sodium restriction are critical management strategies.
- Renal denervation is approved, and novel agents are emerging for true RH in CKD.
Conclusions:
- RH in CKD presents a significant clinical challenge requiring tailored management strategies.
- Further research is needed to clarify the prevalence and long-term outcomes of true RH in CKD.
- Provider-patient relationships are vital for adherence to lifestyle modifications and medication.
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