Pharmacotherapy for Hypertension in Chronic Kidney Disease: An Overview

Abstract

Chronic kidney disease (CKD) is one of the leading causes of death. It is characterized by progressive decline in glomerular filtration rate (GFR), irreversible structural and functional kidney damage often associated with co-morbidities and multiple complications, including hypertension, diabetes, and cardiovascular diseases. The stages of CKD are classified based on GFR and albuminuria levels, and early detection is important for slowing progression and managing complications. Hypertension (HTN) is one of the leading causes and comorbidities and an independent modifiable risk factor in CKD, and unmanaged HTN progresses to decline in kidney function and kidney damage, resulting in advanced CKD (4 or 5 stage) and end-stage renal disease (ESRD). Both pharmacological and non-pharmacological approaches are involved in the management of HTN in CKD. The review focuses on pharmacotherapy for HTN in CKD patients, with special emphasis on the individualization of therapy based on kidney function, disease stage, and blood pressure status. According to the latest clinical practice guidelines, HTN is preferably treated with RAAS inhibitors (ACEIs or ARBs) alone or in combination with diuretics and/or calcium channel blockers; to some extent, add-on beta-blockers or centrally acting agents are also recommended. Newly recommended treatment strategies include using drugs that provide additional cardiorenal protection and slow kidney damage. Additionally, evidence-based and clinically proven advancements in the management of HTN in CKD are discussed.