title: Pharmacologic Issues in treating hypertension in CKD.
abstract: Antihypertensive drugs are prescribed to patients with CKD to slow down the rate of loss of residual kidney function; to reduce proteinuria, when present; and to protect other target organs from damage that is mediated by elevated blood pressure (BP). In most patients, a diuretic and a renin system blocking drug, such as an angiotensin-converting enzyme inhibitor, angiotensin receptor antagonist, or an aldosterone receptor antagonist are used. Often, 3 or more drugs are needed to achieve BP goals. Many drugs are eliminated through the kidney and in some cases dosage reductions are advisable to avoid adverse effects from high levels of medication. This article will review the various classes of antihypertensive drugs used in the management of high BP in patients with CKD, with an emphasis on pitfalls that arise when kidney function is impaired.
authors.affiliation: Division of Nephrology, Virginia Commonwealth University Health System, Richmond, VA 23298-0160, USA. dsica@mcvh-vcu.edu
authors.forename: Domenic A
authors.initials: DA
authors.lastname: Sica
mesh_terms: D058668:Adrenergic alpha-1 Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D058647:Adrenergic alpha-2 Receptor Agonists / Q000494:pharmacology / Q000627:therapeutic use; D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000494:pharmacology / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000494:pharmacology / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000453:epidemiology; D004232:Diuretics / Q000494:pharmacology / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology*; D000451:Mineralocorticoid Receptor Antagonists; D051436:Renal Insufficiency, Chronic / Q000188:drug therapy* / Q000453:epidemiology*; D000092502:Renin Inhibitors
chemical_list: D058668:Adrenergic alpha-1 Receptor Antagonists; D058647:Adrenergic alpha-2 Receptor Agonists; D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D000092502:Renin Inhibitors