Current issues in the management and monitoring of hypertension in chronic kidney disease

Abstract

Purpose of review This review highlights recent developments in the management and monitoring of hypertension in adults with chronic kidney disease (CKD), not on dialysis. Recent findings Ambulatory blood pressure (BP) monitoring and self-measured BP monitoring can classify abnormal BP patterns better than clinic BP readings. Self-measured BP monitoring lowers BP and allows tailoring of antihypertensive treatment. Dosing of antihypertensive medication at night improves nocturnal hypertension. Recent guidelines recommend a BP target less than 140/90 mmHg for patients with CKD without proteinuria and less than 130/80 mmHg for those with proteinuria. Lower salt intake is associated with a greater effect of rennin–angiotensin–aldosterone system blockage in CKD. Lifestyle modification resulting in weight loss reduces BP in individuals with CKD. Of overweight or obese CKD patients, 8% report taking weight loss medication, which is a potential safety concern. Weight loss from intensive lifestyle modification in individuals with diabetes prevents CKD. Summary Although we have effective tools to monitor and lower BP, we still need clinical outcome studies to inform BP targets for specific age groups, types of CKD disease, and comorbidities. How to treat obesity to improve hypertension and other comorbidities in patients with CKD remains another important area of research.

Resistance to Recombinant Human Erythropoietin Therapy in a Rat Model of Chronic Kidney Disease Associated Anemia

“…Renal failure was accompanied by a compensatory renal hypertrophy and angiogenesis in the CRF rats, as revealed by the increase in KW/BW and serum VEGF levels; a high HW/BW ratio was also found in the CRF group, which might be caused by the supplementary effort of the left ventricle muscle to pump blood in this condition of anemia secondary to renal failure development ( Table 1 ). CKD patients usually present a concomitant rise in systolic blood pressure [ 47 , 48 , 49 , 50 ], which was also observed in the CRF rats of our study, explaining the cardiac hypertrophy. When treated with 200 IU rHuEPO, there was an aggravation of hypertension, which is a widely described rHuEPO side-effect [ 47 , 48 , 49 , 50 ] that contributes to high morbidity and mortality of CKD patients [ 28 , 48 ].…”

Olmesartan‐based monotherapy vs combination therapy in hypertension: A meta‐analysis based on age and chronic kidney disease status

“…The prevalence of hypertension is even greater among patients with CKD than in the general population 26. Consistent with the results observed in the full analysis set, OM dual‐combination therapy was associated with greater improvements than OM monotherapy among patients with and without CKD.…”

Comparisons between different blood pressure measurement techniques in patients with chronic kidney disease

“…Whereas both WCHT and MHT share a close relationship with target organ damage in patients with CKD, MHT is associated with a level of risk similar to that of persistent HTN [13,14]. Accordingly, ABPM is the best method for monitoring BP in patients with CKD [15–17], and contributes to better renal outcomes [18] and decreased CVD risk [19].…”