Hypertension in chronic kidney disease part 2

Management :

• Lifestyle
• Multiple medication (often 3 or more drugs) are needed to control hypertension adequately in most people with chronic kidney disease
• Consider sleep apnoea as cause of resistant hypertension
• People with diabetes or proteinuria should be treated with an ACE inhibitor or ARB as first line therapy
• When treatment with an ACE inhibitor or ARB is initiated, the GFR can decrease and potassium levels can rise
• If the serum potassium concentration is greater than 6 mmol/l despite dose reduction, diuretic therapy and dietary potassium restriction, then any ACE inhibitor, ARB or spironolactone should be stopped
• Diuretics should be used in most individuals. Both non loop diuretics (e.g. thiazide) and loop diuretics ( e.g furosemide) are effective at all stages of chronic kidney disease as adjunct antihypertensive therapy
• Additional antihypertensive agents can be chosen based on cardiovascular indications and comorbidities
• Beta-blocker may be useful in people with coronary heart disease, tachyarrhytmias and heart failure, but are contra indicated in asthma and heart block
• Calcium channel blockers may be used for people with angina, the elderly and those with systolic hypertension
• Combine therapy with ACE inhibitor and ARB is not recomended