Management of Hypertension in End-Stage CKD

Guideline Recommendations

• The American College of Cardiology recommends considering alpha-1 blockers like prazosin as second-line agents in patients with concomitant benign prostatic hyperplasia, although they are associated with orthostatic hypotension, especially in older adults 1
• The European Society of Cardiology guidelines recommend treating office BP ≥140/90 mmHg in patients with diabetic or non-diabetic CKD with lifestyle advice and BP-lowering medication, targeting systolic BP to 130-139 mmHg in most cases, or 120-129 mmHg in moderate-to-severe CKD with eGFR >30 mL/min/1.73 m² if tolerated 2

Monitoring and Safety Considerations

• Patients with end-stage CKD require regular monitoring of potassium, particularly if on other medications affecting potassium homeostasis, as recommended by the European Heart Journal and Diabetes Care 2, 3
• The American College of Cardiology and European Heart Journal suggest considering mineralocorticoid receptor antagonists, such as spironolactone, for resistant hypertension, and dihydropyridine calcium channel blockers as effective alternatives in CKD, with careful monitoring for hyperkalemia 1, 2