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Review
. 2019 May 7;14(5):757-764.
doi: 10.2215/CJN.04330418. Epub 2018 Nov 13.

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

Arjun D Sinha  1   2 , Rajiv Agarwal  1   2
Affiliations
Review

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

Arjun D Sinha et al. Clin J Am Soc Nephrol. .

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.

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Figures

Figure 1.
Figure 1.
Major antihypertensive drug classes and their mechanisms. Cl, chlorine; K, potassium; Na, sodium.
See this image and copyright information in PMC

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