Tags

Type your tag names separated by a space and hit enter

Hypertension in Chronic Kidney Disease.
Adv Exp Med Biol. 2017; 956:307-325.AE

Abstract

Hypertension, a global public health problem, is currently the leading factor in the global burden of disease. It is the major modifiable risk factor for heart disease, stroke and kidney failure. Chronic kidney disease (CKD) is both a common cause of hypertension and CKD is also a complication of uncontrolled hypertension. The interaction between hypertension and CKD is complex and increases the risk of adverse cardiovascular and cerebrovascular outcomes. This is particularly significant in the setting of resistant hypertension commonly seen in patient with CKD. The pathophysiology of CKD associated hypertension is multi-factorial with different mechanisms contributing to hypertension. These pathogenic mechanisms include sodium dysregulation, increased sympathetic nervous system and alterations in renin angiotensin aldosterone system activity. Standardized blood pressure (BP) measurement is essential in establishing the diagnosis and management of hypertension in CKD. Use of ambulatory blood pressure monitoring provides an additional assessment of diurnal variation in BP commonly seen in CKD patients. The optimal BP target in the treatment of hypertension in general and CKD population remains a matter of debate and controversial despite recent guidelines and clinical trial data. Medical therapy of patients with CKD associated hypertension can be difficult and challenging. Additional evaluation by a hypertension specialist may be required in the setting of treatment resistant hypertension by excluding pseudo-resistance and treatable secondary causes. Treatment with a combination of antihypertensive drugs, including appropriate diuretic choice, based on estimated glomerular filtration rate, is a key component of hypertension management in CKD patients. In addition to drug treatment non-pharmacological approaches including life style modification, most important of which is dietary salt restriction, should be included in the management of hypertension in CKD patients.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, Sidney Kimmel School of Medicine, Thomas Jefferson University, 833 Chestnut Street, Suite 700, Philadelphia, PA, 19107, USA. seyed.hamrahian@Jefferson.edu.Division of Nephrology, Department of Medicine, Sidney Kimmel School of Medicine, Thomas Jefferson University, 833 Chestnut Street, Suite 700, Philadelphia, PA, 19107, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

27873228

Citation

Hamrahian, Seyed Mehrdad, and Bonita Falkner. "Hypertension in Chronic Kidney Disease." Advances in Experimental Medicine and Biology, vol. 956, 2017, pp. 307-325.
Hamrahian SM, Falkner B. Hypertension in Chronic Kidney Disease. Adv Exp Med Biol. 2017;956:307-325.
Hamrahian, S. M., & Falkner, B. (2017). Hypertension in Chronic Kidney Disease. Advances in Experimental Medicine and Biology, 956, 307-325. https://doi.org/10.1007/5584_2016_84
Hamrahian SM, Falkner B. Hypertension in Chronic Kidney Disease. Adv Exp Med Biol. 2017;956:307-325. PubMed PMID: 27873228.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypertension in Chronic Kidney Disease. AU - Hamrahian,Seyed Mehrdad, AU - Falkner,Bonita, PY - 2016/11/23/pubmed PY - 2017/10/31/medline PY - 2016/11/23/entrez KW - Adults KW - Ambulatory blood pressure monitoring KW - Blood pressure KW - Chronic kidney disease KW - Hypertension KW - Masked hypertension KW - Resistant hypertension KW - Salt KW - Sodium KW - White coat hypertension SP - 307 EP - 325 JF - Advances in experimental medicine and biology JO - Adv. Exp. Med. Biol. VL - 956 N2 - Hypertension, a global public health problem, is currently the leading factor in the global burden of disease. It is the major modifiable risk factor for heart disease, stroke and kidney failure. Chronic kidney disease (CKD) is both a common cause of hypertension and CKD is also a complication of uncontrolled hypertension. The interaction between hypertension and CKD is complex and increases the risk of adverse cardiovascular and cerebrovascular outcomes. This is particularly significant in the setting of resistant hypertension commonly seen in patient with CKD. The pathophysiology of CKD associated hypertension is multi-factorial with different mechanisms contributing to hypertension. These pathogenic mechanisms include sodium dysregulation, increased sympathetic nervous system and alterations in renin angiotensin aldosterone system activity. Standardized blood pressure (BP) measurement is essential in establishing the diagnosis and management of hypertension in CKD. Use of ambulatory blood pressure monitoring provides an additional assessment of diurnal variation in BP commonly seen in CKD patients. The optimal BP target in the treatment of hypertension in general and CKD population remains a matter of debate and controversial despite recent guidelines and clinical trial data. Medical therapy of patients with CKD associated hypertension can be difficult and challenging. Additional evaluation by a hypertension specialist may be required in the setting of treatment resistant hypertension by excluding pseudo-resistance and treatable secondary causes. Treatment with a combination of antihypertensive drugs, including appropriate diuretic choice, based on estimated glomerular filtration rate, is a key component of hypertension management in CKD patients. In addition to drug treatment non-pharmacological approaches including life style modification, most important of which is dietary salt restriction, should be included in the management of hypertension in CKD patients. SN - 0065-2598 UR - https://www.unboundmedicine.com/medline/citation/27873228/Hypertension_in_Chronic_Kidney_Disease_ L2 - https://dx.doi.org/10.1007/5584_2016_84 DB - PRIME DP - Unbound Medicine ER -