Clinical Pharmacology of Antihypertensive Therapy for the Treatment of Hypertension in CKD

Abstract

CKD is common and frequently complicated with hypertension both predialysis and in ESKD. As a major modifiable risk factor for cardiovascular disease in this high-risk population, treatment of hypertension in CKD is important. We review the mechanisms and indications for the major classes of antihypertensive drugs, including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β-adrenergic blocking agents, dihydropyridine calcium channel blockers, thiazide diuretics, loop diuretics, mineralocorticoid receptor blockers, direct vasodilators, and centrally acting α-agonists. Recent evidence suggests that β-adrenergic blocking agents may have a greater role in patients on dialysis and that thiazide diuretics may have a greater role in patients with advanced CKD. We conclude with sharing our general prescribing algorithm for both patients with predialysis CKD and patients with ESKD on dialysis.

Keywords: Adrenergic beta-Antagonists; Algorithms; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Calcium Channel Blockers; Dihydropyridines; Kidney Failure, Chronic; NR3C2 protein, human; Pharmacology, Clinical; Receptors, Mineralocorticoid; Sodium Chloride Symporter Inhibitors; Sodium Potassium Chloride Symporter Inhibitors; Vasodilator Agents; hypertension; renal dialysis; risk factors.