Hypertension approach in patients with chronic kidney disease

Most patients with chronic kidney disease (CKD) have hypertension, and CKD is characterized by high and very high cardiovascular disease rates. Hypertension is an important cardiovascular risk factor, and its treatment prevents major cardiovascular events and lowers mortality of all causes and especially cardiovascular mortality. Therefore antihypertensive therapy is part of the management of chronic kidney disease. Effective blood pressure control decreases not only the risk of fatal and non-fatal cardiovascular events, but also reduces the rate of progression of renal impairment. Target bloodline values are not definitively established, but most guidelines recommend lowering systolic blood pressure to values below 140-130 mmHg, depending on the presence of proteinuria. Additional studies are needed to establish the blood pressure (BP) target, especially for patients with GFR below 45 ml/min./1.73 m2, where the benefits of too aggressive BP may be outweighed by the risk of progression to renal insufficiency. Most patients with chronic kidney disease require therapy with two or three therapeutic agents, the most commonly used drugs being ACE inhibitors/ARB (if there is intolerance to ACE inhibitors), calcium channel blockers and diuretics.