Hypertension as Cardiovascular Risk Factor in Chronic Kidney Disease

Abstract

Hypertension is the leading modifiable cause of premature death and hence one of the global targets of World Health Organization for prevention. Hypertension also affects the great majority of patients with chronic kidney disease (CKD). Both hypertension and CKD are intrinsically related, as hypertension is a strong determinant of worse renal and cardiovascular outcomes and renal function decline aggravates hypertension. This bidirectional relationship is well documented by the high prevalence of hypertension across CKD stages and the dual benefits of effective antihypertensive treatments on renal and cardiovascular risk reduction. Achieving an optimal blood pressure (BP) target is mandatory and requires several pharmacological and lifestyle measures. However, it also requires a correct diagnosis based on reliable BP measurements (eg, 24-hour ambulatory BP monitoring, home BP), especially for populations like patients with CKD where reduced or reverse dipping patterns or masked and resistant hypertension are frequent and associated with a poor cardiovascular and renal prognosis. Even after achieving BP targets, which remain debated in CKD, the residual cardiovascular risk remains high. Current antihypertensive options have been enriched with novel agents that enable to lower the existing renal and cardiovascular risks, such as SGLT2 (sodium-glucose cotransporter-2) inhibitors and novel nonsteroidal mineralocorticoid receptor antagonists. Although their beneficial effects may be driven mostly from actions beyond BP control, recent evidence underline potential improvements on abnormal 24-hour BP phenotypes such as nondipping. Other promising novelties are still to come for the management of hypertension in CKD. In the present review, we shall discuss the existing evidence of hypertension as a cardiovascular risk factor in CKD, the importance of identifying hypertension phenotypes among patients with CKD, and the traditional and novel aspects of the management of hypertensives with CKD.

Comparative mathematical modeling of causal association between metal exposure and development of chronic kidney disease

“…Through LASSO regression analysis, we identified a positive association between Na and CKD, even after adjusting for covariates such as general characteristics and routine blood markers. This aligns with the results of a retrospective cohort study ( 16 ), possibly because excessive Na intake can elevate blood pressure, a known risk factor for CKD ( 17 ). However, it has also been observed that both low and high concentrations of Na ion are associated with increased mortality risk in CKD patients ( 18 ).…”

Ambulatory and home blood pressure monitoring for cardiovascular disease risk evaluation: a systematic review and meta-analysis of prospective cohort studies

“…However, when hypertension exists, this risk could be higher. It seems that patients with chronic kidney disease presents higher rates of uncontrolled hypertension when evaluated with ABPM, compared with OBPM, as well as high rates of masked hypertension and nondipping status during sleep, conditions further related with poor cardiovascular outcomes [53,54]. Hence, BP evaluation and control could not be relied only on OBPM in hypertensive individuals with chronic kidney disease.…”

Association between medical complications according to continuity of care and medication adherence in patients with hypertension in Korea: a national population-based cohort study

“…In this study, we selected diabetes and dyslipidaemia as comorbidities, which are cofactors of cardiovascular disease, cerebrovascular disease and hypertensive nephropathy. [25][26][27] These two types of disease could affect the incidence of hypertensive complications.…”