Treatment of Hypertension in Patients with Chronic Kidney Disease

Patients with hypertension and chronic kidney disease (CKD) younger than 80 years should have their blood pressure reduced to less than 140/90 mm Hg. Patients with hypertension and CKD aged 80 years and older should have their systolic blood pressure reduced to 140 to 150 mm Hg if tolerated. Patients with hypertension and CKD should be treated with either an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker but not with both drugs simultaneously. Controlled studies comparing stenting plus medical therapy versus medical therapy alone show that for the vast majority of patients with renal artery stenosis and either hypertension or CKD, management of renal artery stenosis should be limited to medical therapy. The Symplicity HTN-3 study showed in 535 patients with resistant hypertension that renal denervation was not better than a sham procedure in reducing the primary efficacy endpoint of change in office systolic blood pressure at 6 months and the secondary efficacy endpoint of change in means 24-hour ambulatory systolic blood pressure at 6 months.