Strategy for treatment of hypertension in patients with chronic kidney diseases / 中国实用内科杂志

ABSTRACT

Hypertension control is the most important and effective treatment for chronic kidney diseases.Compared with hypertension patients without kidney diseases,it requires a stricter blood pressure control in those with kidney diseases.The treatment principles are(i)To lower the blood pressure is the top priority;and(ii)the impacts of various antihypertensive drugs on individual patients.The antihypertensive drugs should be chosen taking into consideration of the following factorsthe extent of hypertension,whether the hypertension occurs abruptly or permanently,the heart and renal functions and any significant metabolic disorders.Among the existing drugs,diuretic is usually hampered by renal dysfunction;ACEI/ARB seems to be more effective on patients with proteinuria,but it should be used with caution in patients with severe renal insufficiency;CCB is effective and can quickly lower blood pressure,therefore it is an essential drug for hypertension treatment;?-blocker is not considered as a main drug for hypertension with kidney diseases.Combination use of anti-hypertensive drug is common to many CKD with hypertension,among them ACEI/ARB+diuretic,ACEI/ARG+CCB are the most common combinations.ACEI+ARB exhibit a better proteinuria reduction effect;however it is not indicated in patients with severe cardiovascular lesion.Hypertension treatment should take into consideration of individual differences and should be adjusted according to individual responses.Salt intake control also plays an important role in the successful treatment of hypertension with kidney diseases.