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 themajor classes of antihypertensive drugs, including angiotensinconverting 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. Weconclude with sharing our general prescribing algorithm for both patientswith predialysis CKD and patients with ESKD on dialysis.