Hypertension in Chronic Kidney Disease.
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.
['Hamrahian|Seyed Mehrdad|SM|', 'Falkner|Bonita|B|']
D000959:Antihypertensive Agents D001794:Blood Pressure D018660:Blood Pressure Monitoring, Ambulatory D015897:Comorbidity D004039:Diet, Sodium-Restricted D004599:Electric Stimulation Therapy D005919:Glomerular Filtration Rate D006801:Humans D006973:Hypertension D007668:Kidney D051436:Renal Insufficiency, Chronic D012084:Renin-Angiotensin System D012307:Risk Factors D040242:Risk Reduction Behavior D012982:Sodium, Dietary D013562:Sympathectomy D013564:Sympathetic Nervous System D016896:Treatment Outcome
Hypertension Chronic kidney disease Resistant hypertension Sodium Blood pressure Ambulatory blood pressure monitoring Salt Adults Masked hypertension White coat hypertension