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Published online: 13 February 2019
© The Author(s) 2019
Abstract
Chronic kidney disease (CKD) is an increasingly prevalent condition globally and is strongly associated with incident cardiovascular disease (CVD). Hypertension is both a cause and effect of CKD and affects the vast majority of CKD patients. Control of hypertension is important in those with CKD as it leads to slowing of disease progression as well as reduced CVD risk. Existing guidelines do not offer a consensus on optimal blood pressure (BP) targets. Therefore, an understanding of the evidence used to create these guidelines is vital when considering how best to manage individual patients. Nonpharmacological interventions are useful in reducing BP in CKD but are rarely sufficient to control BP adequately. Patients with CKD and hypertension will often require a combination of antihypertensive medications to achieve target BP. Certain pharmacological therapies provide additional BP-independent renoprotective and/or cardioprotective action and this must be considered when instituting therapy. Managing hypertension in the context of haemodialysis and following kidney transplantation presents further challenges. Novel therapies may enhance treatment in the near future. Importantly, a personalised and evidence-based management plan remains key to achieving BP targets, reducing CVD risk and slowing progression of CKD.
1Introduction
Chronic kidney disease (CKD) affects 10-15% of the population worldwide and its prevalence is increasing [1, 2]. CKD is defined as the presence of reduced kidney function (an estimated glomerular filtration rate [eGFR] < 60 mL/ min/1.73 m2 [3]) or kidney damage (often indicated by the presence of proteinuria) for > 3 months duration [4]. Hypertension, defined by the European Society of Cardiology and the European Society of Hypertension (ESC/ESH) as a blood pressure (BP) of > 140/80 mmHg affects ~ 30% of the general adult population and up to 90% of those with CKD [5, 6].
Hypertension is both a cause and effect of CKD and contributes to its progression [7-9]. As eGFR declines, the incidence and severity of hypertension increase [5]. Additionally, hypertension and CKD are both independent risk factors for cardiovascular disease (CVD). When both exist together the risks of CVD morbidity and mortality are substantially increased [10]. For those with stage 3 (eGFR 30-59 mL/min/1.73 m2) or stage 4 (eGFR 15-29 mL/ min/1.73 m2) CKD, defined according to the Kidney...