From the Guidelines
Antihypertensive medications used in Chronic Kidney Disease (CKD) include ACE inhibitors, ARBs, and mineralocorticoid receptor antagonists.
Key Medications
- ACE inhibitors: reduce the risk of kidney failure and major cardiovascular events, and are recommended for patients with CKD, particularly those with diabetes and albuminuria 1
- ARBs: also reduce the risk of kidney failure and major cardiovascular events, and are recommended for patients with CKD, particularly those with diabetes and albuminuria 1
- Mineralocorticoid receptor antagonists: effective for management of resistant hypertension, reduce albuminuria, and may have additional cardiovascular benefits, but may increase the risk of hyperkalemia 1
Additional Considerations
- Combination therapy: often required for patients with CKD, particularly those with diabetes and albuminuria, but the combined use of ACE inhibitors and ARBs should be avoided due to increased risk of hyperkalemia and AKI 1
- Blood pressure targets: <130/80 mmHg is recommended to reduce CVD mortality and slow CKD progression, but lower targets may be suitable for some patients, particularly those with severely elevated albuminuria 1
- Other antihypertensive agents: such as thiazide diuretics, loop diuretics, and CCBs, may be used in patients with CKD, particularly those with advanced disease or volume overload 1
From the Research
Antihypertensive Medications Used in Chronic Kidney Disease (CKD)
The following antihypertensive medications are used in the treatment of CKD:
- Angiotensin-converting enzyme (ACE) inhibitors, which are recommended as the first-line treatment for patients with CKD and/or diabetes with albuminuria 2, 3, 4
- Angiotensin II receptor blockers (ARBs), which are used if ACE inhibitors are not tolerated 3, 4
- Calcium channel blockers, including non-dihydropyridine and dihydropyridine types, which can be used in combination with ACE inhibitors or ARBs 3, 4
- Diuretics, which are commonly used and represent a cornerstone in the management of CKD patients 4, 5
- Beta-blockers, which are also used in the treatment of CKD, although they are not the first-line treatment 6
- Aldosterone antagonists, such as spironolactone, which can be used in patients with treatment-resistant hypertension, but require careful monitoring of potassium levels 5
Treatment Goals and Strategies
The treatment goals for patients with CKD include:
- Achieving a blood pressure goal of <130/80 mmHg 4, 5
- Reducing proteinuria and slowing the decline in kidney function 2, 3
- Using lifestyle modifications and multiple antihypertensive medications as needed 4
- Monitoring potassium levels and kidney function regularly, especially when using certain medications such as spironolactone 5
Emerging Therapies
Newer agents, such as non-steroidal mineralocorticoid receptor antagonists, dual endothelin receptor antagonists, and aldosterone synthase inhibitors, are being developed and may offer novel targets and strategies for controlling blood pressure in patients with CKD 5