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Hypertension and Chronic Kidney Disease

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Management of Chronic Kidney Disease

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Abstract

Hypertension and chronic kidney disease (CKD) commonly co-exist and the interrelation between these two pathophysiological states is bidirectional. Sustained uncontrolled hypertension can accelerate the progression of kidney injury to end-stage kidney disease and progressive decline in kidney function can conversely lead to more difficult-to-control hypertension. The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend that patients with hypertension and CKD should be treated with a systolic blood pressure (BP) target of <120 mmHg, using standardized office BP measurements as a tool to guide the management of hypertension. There is currently no clinical-trial evidence to prove that intensive BP control is effective in retarding the progression of CKD, but strong evidence from the Systolic Blood Pressure Intervention Trial (SPRINT) have demonstrated an impressive benefit of intensive BP-lowering on cardiovascular outcomes and all-cause mortality. Angiotensin-converting-enzyme-inhibitors or angiotensin-receptor-blockers are recommended as first-line antihypertensive therapies in patients with high BP, CKD, and moderately-to-severely increased albuminuria. Other guideline-directed strategies to offer cardiorenal protection in patients with CKD and type 2 diabetes are the use of sodium-glucose co-transporter type 2 inhibitors as well as mineralocorticoid receptor antagonism with finerenone.

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Conflicts of Interest

R.A. reports personal fees and nonfinancial support from Bayer Healthcare Pharmaceuticals, Akebia Therapeutics, Boehringer Ingelheim, Eli Lilly, Relypsa, Vifor Pharma, Lexicon and Reata; is a member of data safety monitoring committees for Vertex and Chinook and a member of steering committees of randomized trials for Akebia Therapeutics, Bayer and Reata; has served as an associate editor of the American Journal of Nephrology and Nephrology Dialysis and Transplantation and has been an author for UpToDate; and has received research grants from the National Institutes of Health and the US Veterans Administration.

P.I.G. has nothing to disclose.

Financial Support

R.A. is supported by the National Heart Lung and Blood Institute (grant R01 HL126903).

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Authors and Affiliations

  1. 2nd Department of Nephrology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Panagiotis I. Georgianos

  2. Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA

    Rajiv Agarwal

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Correspondence to Rajiv Agarwal .

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  1. Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Türkiye

    Mustafa Arıcı

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Georgianos, P.I., Agarwal, R. (2023). Hypertension and Chronic Kidney Disease. In: Arıcı, M. (eds) Management of Chronic Kidney Disease. Springer, Cham. https://doi.org/10.1007/978-3-031-42045-0_5

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