From the Research
Reversal of Chronic Kidney Disease (CKD) in Uncontrolled Hypertension
- The relationship between hypertension and CKD is complex, with sustained hypertension leading to worsening kidney function and progressive decline in kidney function conversely leading to worsening blood pressure control 1.
- Uncontrolled hypertension can lead to significant cardiovascular morbidity and mortality and accelerate progression to end-stage kidney disease 1, 2.
- Intensive blood pressure control has been shown to reduce the risk for adverse cardiovascular outcomes and mortality in the CKD population, but its effect on slowing the progression of CKD is unclear 1, 2.
Management of Hypertension in CKD
- The main approaches to the management of hypertension in CKD include dietary salt restriction, initiation of treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and diuretic therapy 1.
- Achieving an optimal blood pressure target is mandatory and requires several pharmacological and lifestyle measures, including correct diagnosis based on reliable blood pressure measurements 3.
- Current antihypertensive options have been enriched with novel agents that enable lowering of existing renal and cardiovascular risks, such as SGLT2 inhibitors and novel nonsteroidal mineralocorticoid receptor antagonists 3.
Blood Pressure Control and CKD Progression
- Better blood pressure control and dipping status changes have been associated with better renal function and proteinuria, and also less cardio-cerebrovascular damages 4.
- Good initial and follow-up blood pressure control statuses have been associated with less left ventricular hypertrophy and more stable changes in estimated glomerular filtration rate (eGFR) and proteinuria 4.
- The optimal control of blood pressure in patients with CKD is still debated, with some studies suggesting a lower systolic blood pressure target may be associated with a higher risk of adverse kidney outcomes 2.