Pharmacologic Treatment of Hypertension in Patients With Chronic Kidney Disease
- PDF / 329,073 Bytes
- 12 Pages / 595.276 x 790.866 pts Page_size
- 62 Downloads / 239 Views
REVIEW ARTICLE
Pharmacologic Treatment of Hypertension in Patients With Chronic Kidney Disease Hari Talreja • Marcel Ruzicka Brendan B. McCormick
•
Published online: 4 April 2013 Ó Springer International Publishing Switzerland 2013
Abstract Hypertension remains an important cause of morbidity and mortality in patients with chronic kidney disease. It both contributes to and is a consequence of chronic renal dysfunction. There is a high prevalence of hypertension in chronic kidney disease, and rates of control remain sub-optimal. Numerous studies have highlighted the benefit of treating hypertension in reducing the overall mortality as well as progression of renal disease in this population. Non-pharmacologic treatment strategies remain the primary intervention in all patients but are insufficient on their own to control hypertension in most cases. Pharmacologic treatment recommendations, however, vary depending on the specific etiology of disease as well as patient characteristics. Though most classes of antihypertensive drugs can be used to lower blood pressure in chronic kidney disease, therapy needs to be selected based on the presence of specific co-morbidities as well as the etiology of the kidney disease. Most patients will require multi-drug therapy for achieving target blood pressure goals. This review discusses the pharmacologic options in management of hypertension in various forms of chronic kidney disease.
1 Introduction The prevalence of hypertension in chronic kidney disease (CKD) varies with the etiology of the kidney disease and H. Talreja M. Ruzicka B. B. McCormick Department of Medicine, University of Ottawa, Ottawa, Canada B. B. McCormick (&) Ottawa Hospital, Riverside Campus 1967 Riverside Dr., Ottawa, ON K1H 7W9, Canada e-mail: [email protected]
stage of CKD, but it is higher than in the general population [1]. For example, the overall prevalence of hypertension reported in the recently published Chronic Renal Insufficiency Cohort (CRIC) study in patients with estimated glomerular filtration rate (GFR) between 20–70 mL/min/ 1.73 m2 was 86 % [2]. This strong association highlights that CKD is not only a possible negative outcome of long term hypertension [3] but also plays a major role in the development and maintenance of hypertension per se. Over the last decade, guidelines by major national hypertension societies have highlighted that hypertensive patients with CKD are at major risk of adverse cardiovascular and renal outcomes. These guidelines also recommended targets for BP treatment in hypertensive patients with CKD as well as initial BP lowering drugs to be used. In addition to that, several new classes of BP lowering drugs were introduced to clinical practice over the last two to three decades, including blockers of the renin-angiotensin system (RAS) and calcium channel blockers (CCBs). This is indeed important as the majority of hypertensive patients with CKD require three or more BP lowering drugs to achieve recommended BP targets. As a result of the above, awarene
Data Loading...
