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Hypertension in CKD: Core Curriculum 2019.
Am J Kidney Dis. 2019 07; 74(1):120-131.AJ

Abstract

Hypertension and chronic kidney disease (CKD) are closely interlinked pathophysiologic states, such that sustained hypertension can lead to worsening kidney function and progressive decline in kidney function can conversely lead to worsening blood pressure (BP) control. The pathophysiology of hypertension in CKD is complex and is a sequela of multiple factors, including reduced nephron mass, increased sodium retention and extracellular volume expansion, sympathetic nervous system overactivity, activation of hormones including the renin-angiotensin-aldosterone system, and endothelial dysfunction. Currently, the treatment target for patients with CKD is a clinic systolic BP < 130mm Hg. The main approaches to the management of hypertension in CKD include dietary salt restriction, initiation of treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and diuretic therapy. Uncontrolled hypertension can lead to significant cardiovascular morbidity and mortality and accelerate progression to end-stage kidney disease. Although intensive BP control has not been shown in clinical trials to slow the progression of CKD, intensive BP control reduces the risk for adverse cardiovascular outcomes and mortality in the CKD population.

Authors+Show Affiliations

Division of Nephrology and Pediatric Nephrology, Departments of Medicine and Pediatrics, University of California San Francisco, San Francisco, CA. Electronic address: elaine.ku@ucsf.edu.Houston Kidney Consultants, Houston Methodist Institute for Academic Medicine, Houston, TX.School of Medicine, University of Southern California, Los Angeles, CA.Division of Nephrology and Hypertension, Department of Medicine, University of Maryland, Baltimore, MD.

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Review

Language

eng

PubMed ID

30898362

Citation

Ku, Elaine, et al. "Hypertension in CKD: Core Curriculum 2019." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 74, no. 1, 2019, pp. 120-131.
Ku E, Lee BJ, Wei J, et al. Hypertension in CKD: Core Curriculum 2019. Am J Kidney Dis. 2019;74(1):120-131.
Ku, E., Lee, B. J., Wei, J., & Weir, M. R. (2019). Hypertension in CKD: Core Curriculum 2019. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 74(1), 120-131. https://doi.org/10.1053/j.ajkd.2018.12.044
Ku E, et al. Hypertension in CKD: Core Curriculum 2019. Am J Kidney Dis. 2019;74(1):120-131. PubMed PMID: 30898362.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hypertension in CKD: Core Curriculum 2019. AU - Ku,Elaine, AU - Lee,Benjamin J, AU - Wei,Jenny, AU - Weir,Matthew R, Y1 - 2019/03/19/ PY - 2018/09/07/received PY - 2018/12/20/accepted PY - 2019/3/23/pubmed PY - 2020/3/11/medline PY - 2019/3/23/entrez KW - BP control KW - Hypertension KW - ambulatory blood pressure monitoring (ABPM) KW - antihypertensive agents KW - blood pressure (BP) KW - cardiovascular outcomes KW - chronic kidney disease (CKD) KW - renin-angiotensin system (RAS) KW - review SP - 120 EP - 131 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 74 IS - 1 N2 - Hypertension and chronic kidney disease (CKD) are closely interlinked pathophysiologic states, such that sustained hypertension can lead to worsening kidney function and progressive decline in kidney function can conversely lead to worsening blood pressure (BP) control. The pathophysiology of hypertension in CKD is complex and is a sequela of multiple factors, including reduced nephron mass, increased sodium retention and extracellular volume expansion, sympathetic nervous system overactivity, activation of hormones including the renin-angiotensin-aldosterone system, and endothelial dysfunction. Currently, the treatment target for patients with CKD is a clinic systolic BP < 130mm Hg. The main approaches to the management of hypertension in CKD include dietary salt restriction, initiation of treatment with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and diuretic therapy. Uncontrolled hypertension can lead to significant cardiovascular morbidity and mortality and accelerate progression to end-stage kidney disease. Although intensive BP control has not been shown in clinical trials to slow the progression of CKD, intensive BP control reduces the risk for adverse cardiovascular outcomes and mortality in the CKD population. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/30898362/Hypertension_in_CKD:_Core_Curriculum_2019_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(19)30094-0 DB - PRIME DP - Unbound Medicine ER -