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Hypertension in Advanced Chronic Kidney Disease: Saving the Kidneys or the Heart?

Ekamol Tantisattamo1, Elaine Ku2

  • 1Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine, Orange, CA; Excellent Center for Organ Transplantation, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.

Advances in Kidney Disease and Health
|July 3, 2026
PubMed

Insights

Intensive blood pressure lowering benefits cardiovascular and kidney health, but evidence is limited in advanced chronic kidney disease (CKD). More research is needed for effective hypertension management in high-risk CKD patients.

Area of Science:

  • Cardiology
  • Nephrology
  • Pharmacology

Background:

  • Hypertension is a modifiable risk factor for cardiovascular disease (CVD) and chronic kidney disease (CKD) progression.
  • Intensive blood pressure lowering aims to mitigate cardiorenal risks, but trial data show inconsistencies in advanced kidney dysfunction.
  • Current hypertension management for CKD involves evolving therapeutic strategies.

Purpose of the Study:

  • To review trial-grade evidence on intensive blood pressure lowering for cardiorenal outcomes in hypertension.
  • To discuss the role of various antihypertensive agents in managing hypertension and CKD.
  • To highlight the need for further research in patients with advanced CKD.

Main Methods:

  • Overview of existing clinical trial data.
  • Focus on evidence for intensive blood pressure lowering and antihypertensive agents.
  • Analysis of cardiorenal outcomes in patients with varying degrees of kidney dysfunction.

Main Results:

  • Intensive blood pressure control shows benefits for cardiorenal outcomes.
  • Newer therapies like SGLT2 inhibitors and GLP-1 agonists offer proven benefits but have limited data in advanced CKD.
  • Renin-angiotensin system inhibitors remain a cornerstone, but newer agents expand treatment options.

Conclusions:

  • Hypertension management is crucial for mitigating cardiorenal risks in CKD patients.
  • While newer therapies show promise, their efficacy and safety in advanced CKD require further investigation.
  • High-risk patients with advanced CKD may need tailored antihypertensive strategies due to potential adverse effects.

Keywords:
Advanced CKDHypertensionRAS inhibition

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