Does hypertension (HTN) cause kidney disease?

From the Guidelines

Hypertension (HTN) is a significant cause of kidney disease, and controlling blood pressure is crucial for kidney protection, with a target generally below 130/80 mmHg for those with kidney disease. Uncontrolled high blood pressure damages the blood vessels throughout the body, including the tiny, delicate blood vessels in the kidneys. Over time, this damage reduces the kidneys' ability to filter waste and excess fluid from the blood, potentially leading to chronic kidney disease (CKD) 1. This relationship works both ways, as kidney disease can also cause hypertension, creating a dangerous cycle. Hypertension is the second leading cause of kidney failure after diabetes. The risk increases with both the severity and duration of hypertension.

Key Points to Consider

• The 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline recommends a blood pressure target of less than 130/80 mmHg for patients with CKD 1.
• Medications like ACE inhibitors (such as lisinopril) and ARBs (such as losartan) are particularly beneficial as they reduce pressure within the kidneys' filtering units while providing additional kidney protection beyond blood pressure control 1.
• Lifestyle modifications including reducing sodium intake, maintaining a healthy weight, regular exercise, limiting alcohol, and not smoking also help protect kidney function.
• Early detection through regular blood pressure checks and kidney function tests is important for preventing progressive kidney damage.

Management of Hypertension in CKD

The management of hypertension in patients with CKD requires a comprehensive approach, including lifestyle modifications and pharmacological therapy. The use of ACE inhibitors or ARBs is recommended as first-line therapy for patients with CKD and hypertension, particularly those with albuminuria 1. However, the combination of an ACE inhibitor and an ARB should be avoided due to the increased risk of hyperkalemia and hypotension 1.

Conclusion is not allowed, so the answer just ends here with the last relevant information

The SPRINT study provides evidence that intensive blood pressure management may be beneficial for patients with CKD, with a target blood pressure of less than 130/80 mmHg 1.

From the Research

Hypertension and Kidney Disease

• Hypertension is a common comorbidity in chronic kidney disease (CKD) and is a risk factor for the faster progression of renal damage 2, 3, 4.
• The pathogenesis of hypertensive renal damage involves mediators from various extracellular systems, including the renin-angiotensin system (RAS) 2.
• Proteinuria, which occurs as a consequence of elevated intraglomerular pressure, is also directly nephrotoxic 2.

Relationship Between Hypertension and Kidney Disease

• Hypertension and CKD are intrinsically related, as hypertension is a strong determinant of worse renal and cardiovascular outcomes and renal function decline aggravates hypertension 3.
• The bidirectional relationship between hypertension and CKD is well documented by the high prevalence of hypertension across CKD stages and the dual benefits of effective antihypertensive treatments on renal and cardiovascular risk reduction 3.

Treatment of Hypertension in CKD

• The National Kidney Foundation clinical practice guidelines recommend a blood pressure goal of <130 mmHg systolic and <80 mmHg diastolic for all CKD patients 4.
• Angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers provide efficient control not only of blood pressure, but also of proteinuria, an effect associated with improved long-term nephroprotection compared with other antihypertensive drug classes 2, 4, 5.
• Combinations of ACEi and ARB are helpful in reducing proteinuria and may also lower blood pressure further in some cases 4.

Blood Pressure Control and Kidney Disease Progression

• Increasing evidence from clinical trials indicates that the rate of CKD progression can be lowered by pharmacological interventions, particularly with the blockade of the renin-angiotensin system 5.
• Tight blood-pressure control towards the low-normal range in young patients and patients with proteinuria may provide additional nephroprotective advantages 5.
• Data on slowing progression of CKD or preventing end-stage renal disease with aggressive blood pressure control have not yielded definitive conclusions regarding ideal blood pressure targets 6.