Emerging concept of anti-hypertensive therapy based on ambulatory blood pressure profile in chronic kidney disease

Abstract

Presently hypertensive patients with chronic kidney disease (CKD) particularly diabetic nephropathy are increasing in number, and cardiovascular and renal complications are the most common cause of death in these patients. The control of blood pressure (BP) is an important issue in cardiovascular and renal protection in hypertensive patients with CKD. Although hypertension is usually diagnosed based on measurements of BP recorded during a visit to a physician, that is, office BP, several studies have shown that target organ damage and prognosis are more closely associated with ambulatory BP than with office BP. It should be important to achieve the target absolute BP levels in hypertensive patients obtained either by office or home measurements or by ambulatory recordings for the cardiovascular and renal protection. Noninvasive techniques for measuring ambulatory BP have allowed BP to be monitored during both day and night. Additionally, ambulatory BP monitoring can provide information on circadian BP variation and short-term BP variability, which is suggested to be associated with cardiovascular and renal morbidity and mortality. This review will briefly summarize the emerging concept of anti-hypertensive therapy based on ambulatory BP profile in hypertensive patients with CKD.

Keywords: Blood pressure variability; chronic kidney disease; diabetic nephropathy; hypertension; renin-angiotensin system.

Figure 1

Schema showing the proposed strategy of RAS inhibitor-based combination therapy for hypertensive patients with CKD. ACEI, angiotensin-converting enzyme inhibitor; ARB, Ang II type 1 receptor-specific blocker; BP, blood pressure; CKD, chronic kidney disease; CCB, calcium channel blocker; DRI, direct renin inhibitor; RAS, renin-angiotensin system.

Figure 2

Increasing importance of clinical studies examining effects of various therapeutic intervention such as anti-hypertensive medication and anti-dyslipidemia agent on altered ambulatory BP profile in hypertensive patients with CKD. BP, blood pressure; CKD, chronic kidney disease.