hypertension Archives

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Clinical considerations and strategies for treating hypertension in CKD patients

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Hypertension is both a major cause and consequence of chronic kidney disease (CKD). It is associated with increased risk of cardiac events, stroke and kidney disease progression. The latest National Kidney Foundation Clinical Practice Guidelines recommend a blood pressure goal of <130mmHg systolic and <80mmHg diastolic for all CKD patients, regardless of the level of albuminuria. Several non-pharmacological interventions are recommended to achieve this, including weight loss, salt intake restriction and physical activity. As for pharmacological treatment, a combination of renin-angiotensin system (RAS) blocker (either ACE inhibitor or ARB, in case of ACE inhibitor intolerance) with a calcium channel blocker or a diuretic is recommended as initial therapy in patients with CKD stage 3 or higher. A combination of two RAS blockers is not recommended

Read the article https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfz279/5700448

31 January 2020/by ERA-EDTA

Hypertension guidelines for CKD patients make practicing physicians confused

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In a new CKJ review article, authors discuss the similarities and differences between three major guidelines that deal with hypertension and CKD and call for unified basic concepts to prevent confusion among patients and physicians.

Three major guidelines deal with blood pressure thresholds and targets for hypertensive drug therapy in CKD patients: the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline; the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline and the 2018 European Society of Cardiology (ESC)/European Society of Hypertension (ESH) Guidelines. However, reading the three guidelines leaves the practicing physician confused about the definition of CKD, how hypertension and secondary hypertension should be diagnosed in CKD patients and what the BP thresholds and targets for antihypertensive drug therapy should be for this population. In a new CKJ review article, authors discussthe similarities and differences between these guidelines and call for unified basic concepts to prevent confusion among patients and physicians.

Find the paper in the CKJ here

14 October 2019/by ERA-EDTA

SPRINT trial results: Serum bicarbonate and cardiovascular events in hypertensive adults

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In hypertensive individuals, serum bicarbonate level <22 mEq/L was associated with an increased CVD risk. The effect of intensive BP lowering on CVD outcomes was not modified by the serum bicarbonate level.

Serum bicarbonate concentration <22 mEq/L is independently associated with a high risk of cardiovascular disease (CVD) events in hypertensive individuals, according to the results of a recently published study in the NDT. The effect of intensive blood pressure lowering on CVD outcomes was not modified by the serum bicarbonate level. Future studies should determine the underlying mechanisms linking hypobicarbonatemia with these adverse outcomes, with particular attention to the underlying acid–base abnormality, and should assess if the treatments to correct such abnormality lead to improved CVD outcomes.

Find the paper here

5 September 2019/by ERA-EDTA