Hypertension in CKD: Core Curriculum 2019

Elaine Ku, Benjamin J Lee, Jenny Wei, Matthew R Weir

Research output: Contribution to journalReview article

48 Scopus citations

Abstract

Hypertension and chronic kidney disease (CKD) are closely interlinked pathophysiologic states, such that sustained hypertension can lead to worsening kidney function and progressive decline in kidney function can conversely lead to worsening blood pressure (BP) control. The pathophysiology of hypertension in CKD is complex and is a sequela of multiple factors, including reduced nephron mass, increased sodium retention and extracellular volume expansion, sympathetic nervous system overactivity, activation of hormones including the renin-angiotensin-aldosterone system, and endothelial dysfunction. Currently, the treatment target for patients with CKD is a clinic systolic BP < 130mm Hg. 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. Uncontrolled hypertension can lead to significant cardiovascular morbidity and mortality and accelerate progression to end-stage kidney disease. Although intensive BP control has not been shown in clinical trials to slow the progression of CKD, intensive BP control reduces the risk for adverse cardiovascular outcomes and mortality in the CKD population.

Original languageEnglish (US)
Pages (from-to)120-131
Number of pages12
JournalAmerican journal of kidney diseases : the official journal of the National Kidney Foundation
Volume74
Issue number1
DOIs
StatePublished - Jul 2019

Keywords

  • BP control
  • Hypertension
  • ambulatory blood pressure monitoring (ABPM)
  • antihypertensive agents
  • blood pressure (BP)
  • cardiovascular outcomes
  • chronic kidney disease (CKD)
  • renin-angiotensin system (RAS)
  • review

ASJC Scopus subject areas

  • Nephrology

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