Abstract

MANAGING HYPERTENSION IN CHRONIC KIDNEY DISEASE PATIENTS: GOING BEYOND THE GUIDELINES

*Devi Sri Jalasuthram, Sahithi Gude, Gayathri Kundeti, Manasa Bonakala, Pavani, Padmalatha Kantamaneni

Abstract

Hypertension (HTN) and chronic kidney disease (CKD) are strongly related, having an overlapping cause and effect relationship. Blood pressure (BP) normally rises as kidney function diminishes, and prolonged elevations exacerbate the onset of renal disease. This review discusses current management concerns in HTN in CKD patients, such as altered circadian rhythm, timing of antihypertensive medication administration, BP objectives, diagnostic challenges in identifying secondary types of HTN, and the importance of salt restriction in CKD. HTN in CKD patients is frequently accompanied by a decline in the kidney's ability to eliminate salt. Addressing the salt sensitivity is crucial for managing HTN in CKD. In addition to the well-established use of an ACEI or angiotensin receptor blocker, dietary salt restriction and adequate diuretic therapy are the cornerstones of HTN management in CKD patients. Bedtime administration of antihypertensive drugs can reverse nocturnal blood pressure drops, and future clinical practice guidelines may propose bedtime dosing of one or more antihypertensive medications in CKD patients.

Keywords: Chronic kidney disease, Anti-hypertensive, Hypertension, Circadian Rhythm, Blood pressure, Management.