title: [The role of combination therapy in the management of hypertension in patients with chronic kidney disease].
abstract: Despite an increasing number of hypotensive drugs available on the market, an unsatisfactory percentage of patients achieve expected therapeutic effects in the management of arterial hypertension (HTN). This issue is especially significant as regards patients with chronic kidney disease (CKD), due to a high HTN prevalence in this population of patients and because inappropriately controlled arterial blood pressure (ABP) constitutes an additional factor leading to the progression of this disease. Kidneys play a significant role in the pathophysiology of HTN. Some of the impaired mechanisms for controlling ABP in CKD can be corrected pharmacologically. However, in order to achieve therapeutic effectiveness, a simultaneous intervention at many pathophysiological levels is necessary, and this is associated with the necessity to administer more than one hypotensive drug. It is actually polytherapy that is the real challenge in managing HTN, as it disturbs the so-called compliance, i.e., cooperation and a proper adherence to the physician's orders by the patient. Combined drugs facilitate a multidirectional intervention on the impaired mechanisms for controlling ABP, while offering an uncomplicated treatment protocol. They are especially recommended in groups of patients with a high cardiovascular risk, diabetes and/or with CKD. However, despite a large body of evidence for the improved effectiveness of hypotensive treatment with the use of combination therapy in the general population, there are no multicenter studies performed on the population of CKD patients. Also there are only few reports referring to this issue in the literature. The authors of the present paper have overviewed literature concerning the distinctness of the pathogenesis of HTN in patients with CKD and have evaluated the usefulness of combination therapy in the correction mechanism of the impaired pathophysiological paths. On the basis of the conducted analysis, the combinations of drugs preferred in CKD have been presented. The usefulness of combination therapy in the early stages of CKD has been evidenced. Spe cial attention has been given to the limitations and risks associ ated with combination therapy in CKD, mainly in the advance stages and when the disease progresses rapidly. It has been pointed out that it is particularly important to monitor renal pa rameters, potassium concentrations and clinical situations that require the therapy to be changed into a standard one. It appean that despite the pros and cons of this type of HTN management in CKD, an increasing number of combined drugs available on the market and the chances for a more effective control of ABP in this group of patients with a high cardiovascular risk necessitate further studies.
authors.affiliation: Katedra i Klinika Chorób Wewnetrznych, Gastroenterologii, Kardiologii i Infekcjologii, Uniwersytet Warmiisko-Mazurski, Wydział Nauk Medycznych. beatagiergielewicz@interia.pl
authors.forename: Beata
authors.initials: B
authors.lastname: Januszko-Giergielewicz
authors.forename: Monika
authors.initials: M
authors.lastname: Kubiak
authors.forename: Leszek
authors.initials: L
authors.lastname: Gromadziński
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000188:drug therapy*; D051436:Renal Insufficiency, Chronic / Q000150:complications*
chemical_list: D000959:Antihypertensive Agents; D004338:Drug Combinations