A gradual increase in chronic kidney disease (CKD) patients worldwide has been a challenge in terms of health care professionals after optimizing therapy for CKD. One of the key strategies of CKD management is to delay the progression of kidney disease, as well as reducing the risk factors for
cardiovascular disease (CVD). Hypertension is a significant factor for both CKD progression and CVD. Therefore, taking care of blood pressure should be emphasized to all CKD patients. The proper measurement of blood pressure (BP) has been important for the diagnosis, evaluation, and follow-up on patients with hypertension. The Office Blood Pressure Monitoring (OBPM) has been widely used in clinical practice. Ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM)
have been an alternative BP measurement for selected patients. As many guidelines have set OBPM as a target for blood pressure, patients who measured their blood pressure by ABPM or HBPM, which should be reconsidered to individually determine optimal blood pressure. Several published guidelines on hypertension in CKD have been updated with considering the recent evidence from clinical studies. The target of blood pressure depended on various factors, such as the staging of CKD, albuminuria
levels and other comorbidities. Almost all of the guidelines for CKD patients have been consistent with a target BP of 130/80 mmHg or lower. Furthermore, renin angiotensin aldosterone system (RAAS) blockers, including ACEIs/ARBs have been recommended in a wide range of patients with kidney diseases, particularly in those with albuminuria. Although acute kidney injury and hyperkalemia should be warranted in patients taking ACEIs/ARBs, other potential factors of those adverse effects should be
intensively excluded before reducing the dose or discontinuing the drugs. Therefore, recommending CEIs/ARBs to CKD to patients who tended to benefit from blocking RAAS mechanisms should be encouraged. The selection of other anti-hypertensive medications should be considered based on the comorbidities of the students, adverse effects, important drug interactions, and clinical outcomes from CKD studies. Downloads
Download data is not yet available. References 1. European Society of Cardiology. 2018 ESC/ESH Guideline for the management of arterial hypertension. Eur Hear J 2018;39:3021-104. What antihypertensive is best for CKD?Both dihydropyridine and non-dihydropyridine CCBs are useful in the management of hypertension in CKD. Dihydropyridine CCBs (such as amlodipine) can be used as first-line therapy in non-proteinuric CKD, either alone or in combination.
How is hypertension treated in CKD?The main approaches to the management of hypertension in CKD include dietary salt restriction, initiation of treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and diuretic therapy.
What are the pharmacologic recommendations in the treatment of hypertension?(Related Pathway(s): Hypertension: Initial management.) In the absence of a specific clinical reason, there are three main classes of drugs that are appropriate for initial monotherapy: thiazide diuretics, long-acting calcium channel blockers (most often a dihydropyridine), and ACE inhibitors or ARBs (algorithm 1).
What are the 7 classes of antihypertensive medications?The classes of blood pressure medications include:. Diuretics.. Beta-blockers.. ACE inhibitors.. Angiotensin II receptor blockers.. Calcium channel blockers.. Alpha blockers.. Alpha-2 Receptor Agonists.. Combined alpha and beta-blockers.. |
Clinical Pharmacology of antihypertensive therapy for the treatment of hypertension in CKD
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