title: Role of sodium restriction and diuretic therapy for "resistant" hypertension in chronic kidney disease.
abstract: In patients with chronic kidney disease, an impaired capacity of the kidney to excrete sodium is a major contributor to hypertension. We discuss the role of sodium restriction and diuretic therapy for resistant hypertension in chronic kidney disease. Independent of increasing blood pressure, a sustained high sodium intake also may affect the progression of renal disease adversely. Consequently, dietary sodium restriction and appropriate diuretic therapy are the foundation for the treatment of resistant hypertension. Thiazide-like diuretics have decreasing effectiveness in patients with advancing renal disease; however, they may augment the effectiveness of the more potent loop diuretics. Increasing evidence suggests that spironolactone is an effective adjunct for the treatment of resistant hypertension. Inclusion of other classes of antihypertensive agents to the treatment regimen generally is necessary to counterbalance other mechanisms contributing to resistant hypertension. The effectiveness of these agents is enhanced by dietary sodium restriction and diuretic therapy.
authors.affiliation: Division of Nephrology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Ramapriya
authors.initials: R
authors.lastname: Sinnakirouchenan
authors.affiliation: Division of Endocrinology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI. Electronic address: tkotchen@mcw.edu.
authors.forename: Theodore A
authors.initials: TA
authors.lastname: Kotchen
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use*; D004351:Drug Resistance; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000628:therapy*; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D017673:Sodium Chloride, Dietary / Q000008:administration & dosage*
chemical_list: D000959:Antihypertensive Agents; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D017673:Sodium Chloride, Dietary
keywords: Sodium; chronic kidney disease; diuretics; resistant hypertension