title: Management of hypertension in CKD: beyond the guidelines.
abstract: Hypertension (HTN) and CKD are closely associated with an intermingled cause and effect relationship. Blood pressure (BP) typically rises with declines in kidney function, and sustained elevations in BP hasten progression of kidney disease. This review addresses current management issues in HTN in patients with CKD including altered circadian rhythm of BP, timing of antihypertensive medication dosing, BP targets, diagnostic challenges in evaluating secondary forms of HTN, and the role of salt restriction in CKD. HTN in patients with CKD is often accompanied by a decrease in the kidney's ability to remove salt. Addressing this salt sensitivity is critical for the management of HTN in CKD. In addition to the well-established use of an ACEI or angiotensin receptor blocker, dietary salt restriction and appropriate diuretic therapy make up the mainstay of HTN treatment in patients with CKD. Bedtime dosing of antihypertensive medications can restore nocturnal dips in BP, and future clinical practice guidelines may recommend bedtime dosing of 1 or more antihypertensive medications in patients with CKD.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL. Electronic address: ejudd@uab.edu.
authors.forename: Eric
authors.initials: E
authors.lastname: Judd
authors.affiliation: Division of Nephrology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: David A
authors.initials: DA
authors.lastname: Calhoun
mesh_terms: D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects*; D018660:Blood Pressure Monitoring, Ambulatory; D004039:Diet, Sodium-Restricted / Q000379:methods; D019468:Disease Management; D018450:Disease Progression; D055870:Drug Chronotherapy; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D007677:Kidney Function Tests; D017410:Practice Guidelines as Topic; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents
keywords: Blood pressure; CKD; Hypertension; Resistant; Salt