Managing hypertension medications in people with chronic kidney disease

Managing hypertension medications in people with chronic kidney disease:

• ACE inhibitors (Angiotensin-converting enzyme inhibitor) or ARBs (Angiotensin II receptor blocker) are essential part of the best care approach for many patients in all stage chronic renal disease
• They cause a reduction in glomerular blood flow, and GFR (Glomerular filtration rate) can decline when treatment is initiated
• Providing the GFR reduction is less than 25% within two months of starting therapy, the ACE inhibitors or ARB should be continued
• If the reduction in GFR is more than 25% below the baseline value, the ACE inhibitor or ARB should be ceased and consideration given to referral to a nephrologist
• Combined therapy with ACE inhibitors and ARB should be avoided except with specialist advice
• Caution should be exercised if baseline K+ is ≥5,5 mmol/L, as rises in serum. K+of approximately 0,5 mmol/L are expected
• ACE inhibitors and ARBs  can be safely be prescribed at all stages chronic kidney disease and should not be deliberately avoided just because GFR is reduced