Hypertension in Patients with Chronic Kidney Disease

Abstract

The prevalence of hypertension in chronic kidney disease (CKD) patients exceeds that of the general population. Uncontrolled hypertension plays a significant role in progression to end stage renal disease and results in increased cardiovascular morbidity and mortality. A complex interplay between various pathophysiologic mechanisms is responsible for the development of hypertension in this patient population. The major factors being extracellular volume overload, increased endothelin-1 release and excess renin-angiotensin-aldosterone system and sympathetic nervous system activity. Dietary and lifestyle modifications have synergistic effects to drug therapy in the control of hypertension. There is no single blood pressure target that is optimal for all CKD patients. It is important to individualize the treatment depending on age, the severity of albuminuria, and comorbidities. Drugs blocking the renin-angiotensin-aldosterone system are the recommended first-line antihypertensive agents for most CKD patients. Intradialytic hypertension may be prevented by individualizing the dialysis prescription and using nondialyzable antihypertensives. New onset of hypertension in the elderly or new onset of difficult to control hypertension in a previously well controlled hypertensive patient should prompt the work up for atherosclerotic renal vascular disease.

The Impact of Antihypertensive Drug Therapy in Patients With Chronic Kidney Disease: A Prospective Observational Cohort Study

“…Furosemide accounts for 84.30% followed by Amlodipine 81.37%. The study shows the limited prescription of firstline therapy (RAS) (29.41%), which has been shown to delay the progression of chronic kidney disease (CKD) [27,30]. In the study cohorts, BB (31.37%) (Metoprolol and Atenolol) were commonly prescribed in DM and DD patients than NDD patients [31].…”

“…Usually, a combination of two or more antihypertensive drugs is required to control HTN. Antihypertensive treatment is individualized to each patient depending on the age, severity of albuminuria, tolerance, compliance and specific clinical features [17,21,27].…”

The Beneficial Effects of Allicin in Chronic Kidney Disease Are Comparable to Losartan

“…The allicin or the losartan treatment increased the eNOS expression, but allicin was more effective than losartan. In CKD, the excess of ROS may directly stimulate vascular contraction or reduce nitric oxide, contributing to hypertension [ 40 ]. Moreover, there is an increase of asymmetric dimethylarginine (ADMA), an inhibitor of nitric oxide synthase [ 41 ].…”

Pathophysiology of Hypertension in Chronic Kidney Disease

“…[1] The complex interplay of factors leads to the development and persistence of hypertension in CKD. [2] The major players are extracellular volume (ECV) overload, increased renin-angiotensinaldosterone axis (RAAS) activation, enhanced endothelin-1 release, and sympathetic nervous system (SNS) activation. [2] The dietary and lifestyle factors also have some contributory roles.…”

“…[2] The major players are extracellular volume (ECV) overload, increased renin-angiotensinaldosterone axis (RAAS) activation, enhanced endothelin-1 release, and sympathetic nervous system (SNS) activation. [2] The dietary and lifestyle factors also have some contributory roles. The prevalence of hypertension is higher among patients with CKD when compared to the general population (64.5% vs. 41%).…”