Hypertension in chronic kidney disease part 2

Kidney cartoon 4

 

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
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