Hypertension Treatment for Patients with Advanced Chronic Kidney Disease

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4 Citations (Scopus)

Abstract

Chronic kidney disease is common and frequently complicated with hypertension. As a major modifiable risk factor for cardiovascular disease in this high risk population, treatment of hypertension in chronic kidney disease is of paramount importance. We review the epidemiology and pathogenesis of hypertension in chronic kidney disease and then update the latest study results for treatment including salt restriction, invasive endovascular procedures, and pharmacologic therapy. Recent trials draw into question the efficacy of renal artery stenting or renal denervation for hypertension in chronic kidney disease, as well as renin-angiotensin-aldosterone system blockade as first line therapy of hypertension in end stage renal disease. Positive trial results reemphasize salt restriction and challenge the prevailing prejudice against the use of thiazide-like diuretics in advanced chronic kidney disease. Last, clinical practice guidelines are trending away from recommending tight blood pressure control in chronic kidney disease.

Original languageEnglish
JournalCurrent Cardiovascular Risk Reports
Volume8
Issue number10
DOIs
StatePublished - Oct 3 2014

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Chronic Renal Insufficiency
Hypertension
Therapeutics
Salts
Sodium Chloride Symporter Inhibitors
Endovascular Procedures
Renal Hypertension
Denervation
Renal Artery
Renin-Angiotensin System
Practice Guidelines
Chronic Kidney Failure
Epidemiology
Cardiovascular Diseases
Blood Pressure
Population

Keywords

  • Chronic kidney disease
  • End stage renal disease
  • Hemodialysis
  • Hypertension
  • Resistant hypertension

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology

Cite this

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AU - Agarwal, Rajiv

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AB - Chronic kidney disease is common and frequently complicated with hypertension. As a major modifiable risk factor for cardiovascular disease in this high risk population, treatment of hypertension in chronic kidney disease is of paramount importance. We review the epidemiology and pathogenesis of hypertension in chronic kidney disease and then update the latest study results for treatment including salt restriction, invasive endovascular procedures, and pharmacologic therapy. Recent trials draw into question the efficacy of renal artery stenting or renal denervation for hypertension in chronic kidney disease, as well as renin-angiotensin-aldosterone system blockade as first line therapy of hypertension in end stage renal disease. Positive trial results reemphasize salt restriction and challenge the prevailing prejudice against the use of thiazide-like diuretics in advanced chronic kidney disease. Last, clinical practice guidelines are trending away from recommending tight blood pressure control in chronic kidney disease.

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KW - End stage renal disease

KW - Hemodialysis

KW - Hypertension

KW - Resistant hypertension

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