title: Should diuretics always be included as initial antihypertensive management in early-stage CKD?
abstract: OBJECTIVE
  This review focuses on the need for combined antihypertensive therapy drugs in patients with chronic kidney disease and the relevance of diuretics.
  
  
  RESULTS
  Chronic kidney disease is a high-risk situation characterized by the presence of volume overload-related hypertension, micro/macroalbuminuria and other traditional and nontraditional risk factors. To achieve the blood pressure goal in these patients, combined antihypertensive therapy (including diuretics) is usually required.
  
  
  CONCLUSIONS
  Extracellular volume expansion is an important, if not the most important, contributing factor to hypertension seen in chronic kidney disease. Protection against progression of renal dysfunction has two main requirements: strict blood pressure control and lowering proteinuria to values as near to normal as possible. Diuretics have been a useful tool to manage volume overload and to achieve strict blood pressure control in patients with chronic kidney disease. Albeit other blood pressure-lowering agents offer additional favorable effects independently of blood pressure changes, diuretics will continue to be used in these patients.
authors: Hypertension Unit, Nephrology Department, Hospital 12 de Octubre, Madrid 28041, Spain.
authors: Julian
authors: J
authors: Segura
authors: Luis M
authors: LM
authors: Ruilope
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure / Q000502:physiology; D004232:Diuretics / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D012306:Risk
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics