Clinical Pharmacology of Antihypertensive Therapy for the Treatment of Hypertension in CKD

Research output: Contribution to journalArticle

Abstract

CKD is common and frequently complicated with hypertension both predialysis and in ESKD. As a major modifiable risk factor for cardiovascular disease in this high-risk population, treatment of hypertension in CKD is important. We review the mechanisms and indications for the major classes of antihypertensive drugs, including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β-adrenergic blocking agents, dihydropyridine calcium channel blockers, thiazide diuretics, loop diuretics, mineralocorticoid receptor blockers, direct vasodilators, and centrally acting α-agonists. Recent evidence suggests that β-adrenergic blocking agents may have a greater role in patients on dialysis and that thiazide diuretics may have a greater role in patients with advanced CKD. We conclude with sharing our general prescribing algorithm for both patients with predialysis CKD and patients with ESKD on dialysis.

Original languageEnglish (US)
Pages (from-to)757-764
Number of pages8
JournalClinical journal of the American Society of Nephrology : CJASN
Volume14
Issue number5
DOIs
StatePublished - May 7 2019

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Clinical Pharmacology
Antihypertensive Agents
Hypertension
Sodium Chloride Symporter Inhibitors
Adrenergic Antagonists
Dialysis
Sodium Potassium Chloride Symporter Inhibitors
Mineralocorticoid Receptors
Angiotensin Receptor Antagonists
Calcium Channel Blockers
Therapeutics
Vasodilator Agents
Angiotensin-Converting Enzyme Inhibitors
Cardiovascular Diseases
Population

Keywords

  • Adrenergic beta-Antagonists
  • Algorithms
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Dihydropyridines
  • hypertension
  • Kidney Failure, Chronic
  • NR3C2 protein, human
  • Pharmacology, Clinical
  • Receptors, Mineralocorticoid
  • renal dialysis
  • risk factors
  • Sodium Chloride Symporter Inhibitors
  • Sodium Potassium Chloride Symporter Inhibitors
  • Vasodilator Agents

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

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title = "Clinical Pharmacology of Antihypertensive Therapy for the Treatment of Hypertension in CKD",
abstract = "CKD is common and frequently complicated with hypertension both predialysis and in ESKD. As a major modifiable risk factor for cardiovascular disease in this high-risk population, treatment of hypertension in CKD is important. We review the mechanisms and indications for the major classes of antihypertensive drugs, including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β-adrenergic blocking agents, dihydropyridine calcium channel blockers, thiazide diuretics, loop diuretics, mineralocorticoid receptor blockers, direct vasodilators, and centrally acting α-agonists. Recent evidence suggests that β-adrenergic blocking agents may have a greater role in patients on dialysis and that thiazide diuretics may have a greater role in patients with advanced CKD. We conclude with sharing our general prescribing algorithm for both patients with predialysis CKD and patients with ESKD on dialysis.",
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author = "Arjun Sinha and Rajiv Agarwal",
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AB - CKD is common and frequently complicated with hypertension both predialysis and in ESKD. As a major modifiable risk factor for cardiovascular disease in this high-risk population, treatment of hypertension in CKD is important. We review the mechanisms and indications for the major classes of antihypertensive drugs, including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β-adrenergic blocking agents, dihydropyridine calcium channel blockers, thiazide diuretics, loop diuretics, mineralocorticoid receptor blockers, direct vasodilators, and centrally acting α-agonists. Recent evidence suggests that β-adrenergic blocking agents may have a greater role in patients on dialysis and that thiazide diuretics may have a greater role in patients with advanced CKD. We conclude with sharing our general prescribing algorithm for both patients with predialysis CKD and patients with ESKD on dialysis.

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