Hypertension is very common in patients with chronic kidney disease (CKD), affecting 67-92% of patients. Control of hypertension is important for slowing the loss of kidney function and reducing the risk of further kidney damage. The document discusses several risk factors for hypertension in CKD patients including older age, African descent, overweight or obesity, and concurrent diabetes or heart disease. It also reviews guidelines for treating hypertension in CKD, which generally recommend a target blood pressure under 140/90 mmHg and use of renin-angiotensin system blocking agents along with monitoring of kidney function and potassium levels.

1. Ade Wijaya, MD – December 2019
Hypertension in
Chronic Kidney Disease

2. Introduction
elevated blood pressure
decrease quality of life
TARGET ORGAN DAMAGE: BRAIN, HEART, KIDNEY
Stevens, P. E. & Levin, A. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice
guideline. Ann. Intern. Med.158, 825–830 (2013).

3. Introduction
 Hypertension is the most common comorbidity in
patients with CKD, affecting 67–92% of patients
 The prevalence of hypertension increases with
declining renal function
 Control of hypertension is a major priority in the
management of CKD and represents an important
modifiable factor in slowing further loss of kidney
function
 Elevated blood pressure can occur as a result of CKD
but is also a potent risk factor for CKD progression
Townsend, R. R. & Taler, S. J. Nat. Rev. Nephrol.11, 555–563 (2015)

4. Risk Factors of Hypertension in CKD
 Older age
 African descent
 Overweight or obesity
 Concurrent diagnoses of diabetes mellitus and/or
cardiovascular disease
Rao, M. V., Qiu, Y., Wang, C. & Bakris, G. Hypertension and CKD: Kidney Early Evaluation Program (KEEP) and National Health and Nutrition Examination Survey
(NHANES), 1999–2004. Am. J. Kidney Dis.51 (Suppl. 2), S30–S37 (2008).

5. Blood Pressure Targets and
Treatment Recommendations in CKD

6. Pathogenesis of Hypertension in CKD
Townsend, R. R. & Taler, S. J. Nat. Rev. Nephrol.11, 555–563 (2015)

7. Management
 Salt restriction
 Pharmacological
 Device interventions:
- Renal denervation
- Baroreflex activation therapy
Townsend, R. R. & Taler, S. J. Nat. Rev. Nephrol.11, 555–563 (2015)

8. Summary
 Elevated blood pressure can occur as a result of, and be a
potent risk factor for, chronic kidney disease (CKD) progression
 CKD is associated with dysregulation of various blood pressure
control systems, including the ability to excrete the daily sodium
load, sympathetic activation, renin–angiotensin system activity,
and endothelial function
 Joint National Committee recommends target blood pressure
levels <140/90mmHg in US patients with CKD until 70 years of
age
 Most guidelines for hypertension treatment in CKD recommend
administration of an agent that blocks the renin–angiotensin
system, with follow-up testing of kidney function and serum
potassium concentrations

9. THANK YOU