The Most Recent Approach of Hypertension in Chronic Kidney Disease I Gde Raka Widiana
Division of Nephrology and Hypertension School of Medicine Udayana University Bali Abstract
High blood pressure in chronic kidney disease is an important factor to induce deterioration of remaining kidney function in addition to major risk factor for cardiovascular disease. On the other hand, reduction of kidney function is a novel risk factor for cardiovascular disease. Therefore, appropriate management of hypertension in chronic kidney disease is a key approach to reduce morbidity and mortality of the patients.
In general, Individualize BP targets and agents according to age, co-existent cardiovascular disease and other co-morbidities, risk of progression of CKD, presence or absence of retinopathy (in CKD patients with diabetes) and tolerance of treatment. Inquire about postural dizziness and check for postural hypotension regularly when treating CKD patients with BP-lowering drugs. Encouraging lifestyle modification in patients with CKD to lower BP and improve long-term cardiovascular and other outcomes, including achieving or maintaining a healthy weight (BMI 20 to 25); lowering salt intake to <90 mmol (<2 g) per day of sodium (corresponding to 5 g of sodium chloride), unless contraindicated; undertaking an exercise program compatible with cardiovascular health and tolerance, aiming for at least 30 minutes 5 times per week; limiting alcohol intake to no more than two standard drinks per day for men and no more than one standard drink per day for women. In non-diabetic adults with CKD ND and urine albumin excretion < 30mg per 24 hours (or equivalent*) whose office BP is consistently ≥140mmHg systolic or ≥90mmHg diastolic be treated with BP-lowering drugs to maintain a BP that is consistently <140mmHg systolic and <90mmHg diastolic. This slide reviews the BP treatment threshold and goal in adults aged ≥18 years with CKD. Initiate pharmacologic treatment when systolic ≥140 mm Hg or diastolic ≥90 mm Hg; treat to a goal of <140/90 mm Hg. This recommendation applies to individuals aged <70 years with eGFR or measured GFR <60 mL/min/1.73 m2 and in people of any age with albuminuria at any level of GFR. No recommended BP goal for ages >70 yrs with GFR <60 mL/min/1.73 m2.
