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Hypertension in Chronic Kidney Disease

  • Chapter
Book cover Hypertension: from basic research to clinical practice

Part of the book series: Advances in Experimental Medicine and Biology ((AIM,volume 956))

Abstract

Hypertension, a global public health problem, is currently the leading factor in the global burden of disease. It is the major modifiable risk factor for heart disease, stroke and kidney failure. Chronic kidney disease (CKD) is both a common cause of hypertension and CKD is also a complication of uncontrolled hypertension. The interaction between hypertension and CKD is complex and increases the risk of adverse cardiovascular and cerebrovascular outcomes. This is particularly significant in the setting of resistant hypertension commonly seen in patient with CKD. The pathophysiology of CKD associated hypertension is multi-factorial with different mechanisms contributing to hypertension. These pathogenic mechanisms include sodium dysregulation, increased sympathetic nervous system and alterations in renin angiotensin aldosterone system activity. Standardized blood pressure (BP) measurement is essential in establishing the diagnosis and management of hypertension in CKD. Use of ambulatory blood pressure monitoring provides an additional assessment of diurnal variation in BP commonly seen in CKD patients. The optimal BP target in the treatment of hypertension in general and CKD population remains a matter of debate and controversial despite recent guidelines and clinical trial data. Medical therapy of patients with CKD associated hypertension can be difficult and challenging. Additional evaluation by a hypertension specialist may be required in the setting of treatment resistant hypertension by excluding pseudo-resistance and treatable secondary causes. Treatment with a combination of antihypertensive drugs, including appropriate diuretic choice, based on estimated glomerular filtration rate, is a key component of hypertension management in CKD patients. In addition to drug treatment non-pharmacological approaches including life style modification, most important of which is dietary salt restriction, should be included in the management of hypertension in CKD patients.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Sidney Kimmel School of Medicine, Thomas Jefferson University, 833 Chestnut Street, Suite 700, Philadelphia, PA, 19107, USA

    Seyed Mehrdad Hamrahian & Bonita Falkner

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  1. Seyed Mehrdad Hamrahian
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  2. Bonita Falkner
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Correspondence to Seyed Mehrdad Hamrahian .

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Editors and Affiliations

  1. Department of Clinical Science and Education Södersjukhuset, Karolinska Institutet, Stockholm, Sweden

    Md. Shahidul Islam

  2. Department of Internal Medicine and Emergency Medicine, Uppsala University Hospital, Uppsala, Sweden

    Md. Shahidul Islam

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Hamrahian, S.M., Falkner, B. (2016). Hypertension in Chronic Kidney Disease. In: Islam, M.S. (eds) Hypertension: from basic research to clinical practice. Advances in Experimental Medicine and Biology(), vol 956. Springer, Cham. https://doi.org/10.1007/5584_2016_84

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  • DOI: https://doi.org/10.1007/5584_2016_84

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-44250-1

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