Treatment of hypertension in chronic renal disease

Abstract:

The interaction of arterial hypertension (AH) and chronic kidney disease (CKD) is two-way and complex. Treatment of AH is the most important measure to preserve renal function and reduce cardiovascular complications at all CKD stages. Arterial pressure (AP) target values in patients with CKD are defined based on the presence or absence of proteinuria. Treatment of AH in CKD should be individualized taking into account the comorbidities and the tolerance of the therapy. In addition to non-pharmacological treatment measures, primarily salt intake limitation, it is often necessary to combine multiple classes of antihypertensives, with RAAS blockers and diuretics playing a key role in AP control. In dialysis patients, it is important to achieve optimum „dry“ weight. When choosing an antihypertensive in transplant patients it is necessary to take into account the time elapsed since transplantation and possible interactions with immunosuppressive medications. 

Key words:
arterial hypertension; chronic kidney disease; diuretics; RAAS blockers; salt intake limitation