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Management of hypertension in chronic kidney disease
Tim Doulton1, Pauline A Swift2, Swapnil Hiremath3
1Kent Kidney Care Centre, East Kent Hospitals University NHS Foundation Trust, Ethelbert Road, Canterbury, Kent CT1 3NG, UK.
Insights
Managing hypertension in chronic kidney disease (CKD) involves standardized blood pressure monitoring and specific medication strategies. Treatment aims to achieve blood pressure goals and slow CKD progression, using renin-angiotensin system inhibitors and other agents as needed.
Area of Science:
- Nephrology
- Cardiology
- Pharmacology
Background:
- Hypertension is a significant risk factor for cardiovascular disease and chronic kidney disease (CKD) progression.
- Accurate blood pressure (BP) measurement is crucial, requiring standardization and supplementary monitoring methods like ambulatory and home BP monitoring.
Purpose of the Study:
- To outline current strategies for managing hypertension in patients with CKD.
- To discuss BP targets, lifestyle modifications, and pharmacological treatments, including emerging therapies.
Main Methods:
- Review of current guidelines and evidence for hypertension management in CKD.
- Discussion of BP measurement standardization and monitoring techniques.
- Analysis of pharmacological treatment options, including renin-angiotensin system inhibitors, SGLT2 inhibitors, and MRAs.
Main Results:
- Recommended BP goals are generally <140/90 mmHg, and <130/80 mmHg for high-risk individuals.
- Lifestyle modification, including salt restriction (<5g/day), is essential.
- Pharmacological treatment typically starts with RAS inhibitors, potentially adding SGLT2 inhibitors and MRAs, with further anti-hypertensives used to reach BP goals.
Conclusions:
- Effective hypertension management in CKD requires a multi-faceted approach combining BP monitoring, lifestyle changes, and tailored pharmacotherapy.
- Strategies for managing hyperkalemia are vital to ensure adherence to beneficial medications.
- Emerging therapeutics offer future possibilities for optimizing CKD and hypertension management.
Abstract:
Hypertension is a major risk factor for cardiovascular (CV) disease and progression in chronic kidney disease (CKD). Blood pressure (BP) measurement should be standardised and supplemented by ambulatory and home BP monitoring. BP goals are generally <140/90 and <130/80 mmHg for those at higher risk of CV disease or CKD progression. Lifestyle modification includes restricting salt intake to <5 g/day. Most people with hypertension and CKD, especially those with a urine albumin:creatinine ratio ≥3 mg/mmol, should be treated with a renin-angiotensin system inhibitor to which, in selected individuals, a sodium-glucose co-transporter inhibitors type 2 and non-steroidal mineralocorticoid receptor antagonist may be added, followed by additional antihypertensives to achieve goal BP. Strategies to manage hyperkalaemia (eg low potassium dietary advice and oral potassium binders) should be employed to avoid stopping prognostically beneficial medications. A range of emerging therapeutics, including aldosterone synthase and endothelin antagonists, and renal denervation are briefly discussed.
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