Title:Treatment of Hypertension in Chronic Kidney Disease: Does one Size Fit All? A Narrative Review from a Nephrologist’s Perspective
VOLUME: 10 ISSUE: 3
Author(s):Godela Brosnahan
Affiliation:Division of Renal Diseases and Hypertension, University of Colorado Denver, Anschutz Medical Campus, Mail Stop C 283, 13001 E 17th Place, Aurora, CO 80045-2571, USA.
Keywords:Cardiovascular disease, chronic kidney disease, guidelines, hypertension, proteinuria, randomized controlled trials.
Abstract:The treatment of hypertension in patients with chronic kidney disease is still controversial, particularly in
regards to the intensity of blood pressure lowering. The 2014 guidelines for the management of hypertension in adults
released by the Eighth Joint National Committee (JNC 8) have sparked criticism from nephrologists, and various societies
have issued differing guidelines. In this article we present a few case vignettes and provide a brief review of the various
guidelines, particularly in regards to patients with chronic kidney disease. We review some of the landmark trials that
have influenced guidelines and the practice of nephrology, as well as the limitations of the evidence on which the current
guidelines are based. We discuss treatment for the patients presented in the case vignettes in light of the guidelines and the
evidence. Finally, it will be clear that there is no single BP goal or single drug that is appropriate for all patients, and that
our knowledge base for optimal treatment of hypertension in chronic kidney disease is still limited.
