[Management of hypertension in CKD patients].
The purpose of treatment for chronic kidney disease (CKD) is to preserve the renal function and to prevent the cardiovascular disease (CVD). CKD patients frequently present non-dipper and salt-sensitive type hypertension, which is a powerful predictor for both the CKD and CVD. Many previous clinical studies in CKD patients showed that appropriate blood pressure control was absolutely necessary to prevent the progression of CKD and development of CVD. From these studies, the target blood pressure for CKD patients is determined as less than 130/80 mmHg, if amount of urinary protein < 1 g/day, and 125/75 mmHg, if urinary protein > 1 g/day. Especially, blood pressure control using the RAS (renin-angiotensin system) inhibitor such as ARBs or ACEIs is superior to other classes of antihypertensive agents in reducing the amount of urinary protein and in preserving renal function. Thus, ARBs and/or ACEIs should be administered to CKD patients unless hyperkalemia or excessive increase in serum creatinine level is observed. Furthermore, hypertension in CKD patients is sometimes intractable and other classes of antihypertensive agents should be administered in addition to ARBs or ACEIs to obtain the target blood pressure.
Kusaba
Tetsuro
T
Division of Nephrology, Nantan General Hospital.
Kimura
Kenjiro
K
D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D002908:Chronic Disease; D018450:Disease Progression; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology*; D007674:Kidney Diseases / Q000188:drug therapy* / Q000209:etiology*; D008019:Life Style; D012084:Renin-Angiotensin System / Q000502:physiology
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics