Hypertension in Chronic Kidney Disease

Abstract

The kidneys have been closely linked to blood pressure, physiologically and pathologically. High blood pressure is quite common in patients with chronic kidney disease, with over three quarters of them needing blood pressure lowering medications. The purpose of blood pressure lowering in this population is mainly to decrease the risk of future cardiovascular events rather than kidney failure, based on trial data. Proper blood pressure measurement is a key component for management, with a focus on greater out-ofoffice readings. Non-pharmacological strategies may be beneficial in decreasing blood pressure to a certain extent, but most patients with chronic kidney disease will need multiple medications. Recent trials support intensive blood pressure lowering in chronic kidney disease for cardiovascular protection, though data is limited in patients with diabetic kidney disease. Similarly, limited data is available to decide target blood pressure in patients on kidney replacement therapy.