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

Abstract

Hypertension (HTN) and chronic kidney disease (CKD) are pathophysiologic states that are intimately related, such that long-term HTN can lead to poor kidney function, and renal function decline can lead to worsening blood pressure (BP) control. HTN in CKD is caused by an interplay of factors, including salt and water retention, with extracellular volume expansion, sympathetic nervous system overactivity, renin-angiotensin-aldosterone system activation, and endothelial dysfunction. BP variability in the CKD population is significant, however, and thus requires close monitoring for appropriate management. With accumulating evidence, the diagnosis as well as management of HTN in CKD has been evolving in the last decade. In this comprehensive review based on current evidence and recommendations, we summarize the basics of pathophysiology, BP variability, diagnosis, and management of HTN in CKD with an emphasis on special populations with CKD.

The Possible Effect of β-Blocker Use on the Circulating MMP-2/TIMP-2 System in Patients with Chronic Kidney Disease on Conservative Treatment

“…The prevalence of hypertension is high among patients with CKD, and about 60% of the population requires treatment with three or more antihypertensive drugs, indicating that resistant hypertension is common in CKD. Thus, the early diagnosis as well as proper treatment of hypertension plays a central role in the management of CKD [1,2]. Additionally, achieving optimal blood pressure (BP) is associated with reduced renal and cardiovascular risk in this population [3].…”