Pathophysiological Insights of Hypertension in Patients with Chronic Kidney Disease
Hypertension is a multi-organ disease, and kidneys play a central role in the development of hypertension, although the kidneys are also being a target organ for hypertension-induced damage. The association between hypertension and chronic kidney disease (CKD) is well known. The prevalence of hypertension increases and control of hypertension becomes more difficult as kidney functions decline. Understanding of the pathophysiology of hypertension is critical for the management of hypertension in CKD. However, there are large gaps in our understanding of pathogenesis and treatment of CKD-related hypertension. Basically, high blood pressure is caused by an increase in cardiac output and/or increase of total peripheral resistance. Both can be deteriorated by a variety of different mechanisms in CKD. Sodium retention and extracellular volume expansion are important, but not the only factors contributing to hypertension seen in CKD. Humoral factors such as renin-angiotensin-aldosterone system, endothelin, and non-humoral factors such as mineral bone disorders may also play a major role in the pathogenesis of hypertension in CKD.
KeywordsHypertension Chronic kidney disease Blood pressure Sodium retention Volume overload The Renin Angiotensin Aldosterone System Sympathetic nervous system Endothelins Oxidative stress Nitric oxide Drugs
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