Management of Hypertension in Chronic Kidney Disease

Hypertension is common in patients with chronic kidney disease (CKD) and contributes to risk of progression of CKD and cardiovascular disease. Many factors including alterations in salt and water balance, the sympathetic nervous system, and the renin-angiotensin-aldosterone system underlie the pathophysiology of hypertension in this setting. Careful measurement of blood pressure, including out-of-office measurement, is important. Goal blood pressure for patients with CKD is less than 130/80mmHg. Restriction of dietary salt intake is an important nonpharmacologic intervention, and inhibitors of the renin-angiotensin axis are the cornerstone of drug therapy, especially in patients with proteinuria.