Principles of Antihypertensive Therapy in Chronic Kidney Disease

Numerous studies have documented the high risk of cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). There are several reasons for the high risk of CVD—in particular the older age of patients, the higher prevalence of traditional CVD risk factors (such as hypertension, diabetes and hyperlipidemia), and the presence of CKD-related risk factors such as coronary calcifications from an elevated calcium-phosphorous product. A multidisciplinary strategy is necessary to reduce the risk of CVD in this patient population, and hypertension is only one of the therapeutic areas: The goals of antihypertensive therapy in CKD patients are to lower blood pressure, reduce the risk of CVD, and slow progression of CKD. ACE inhibitors and ARBs are recommended for patients with diabetic kidney diseases and nondiabetic kidney diseases with proteinuria. In these patients, these agents lower blood pressure, reduce proteinuria, slow the progression of kidney disease, and likely reduce CVD risk.