Blood Pressure Targets
| Population | BP Target | Preferred Agents |
|---|---|---|
| SPRINT | SBP < 120 mm Hg | |
| Transplant recipient | < 130/80 mm Hg | ARB, DHP-CCB |
| ADPKD | SBP < 95-110 mm Hg | |
| All others | SBP < 140 mm Hg |
Lifestyle Interventions
- Sodium target < 2 g/day (<90 mM/day, or <5 g NaCl/day) for those with high blood pressure and CKD.
- Not appropriate for those with sodium-wasting nephropathy.
- DASH or salt-substitutes may not be appropriate for those with advanced CKD or other causes of impaired K excretion.
- Physical activity target > 150 minutes moderately intense activity/week, or as tolerated. Modify to the individual's capacity.
Pharmacotherapy
- Diuretics
- Loop
- Thiazide
- ACE inhibitors
- SGLT2 inhibitors
- Calcium channel blockers
Diuretics
Loop Diuretics
The mainstay of treatment of HTN in CKD with urine production.
Thiazide Diuretics
CLICK trial (NEJM 2021) showed that a chlorthalidone-based antihypertensive strategy was: 1. effective (-11 mmHg) and relatively safe in patients with stage 4 CKD (mean eGFR 23) and poorly controlled hypertension (mean 140 mmHg), over 12 weeks 2. It also decreased UACR increase by 50% compared to placebo, over 12 weeks.
References
- Cheung AK, Chang TI, Cushman WC, et al. KDIGO 2021 Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease. Kidney International. 2021;99(3, Supplement):S1-S87. doi:10.1016/j.kint.2020.11.003