Hypertensive Crisis Management in CKD Patients

Blood Pressure Targets and Medication

• The American College of Cardiology recommends reducing blood pressure to <130/80 mmHg for all CKD patients regardless of stage or albuminuria status 1, 2, 3, 4
• The American College of Cardiology suggests initiating or resuming ACE inhibitor therapy for CKD patients with albuminuria ≥300 mg/day (stage 3 or higher, or stage 1-2 with significant albuminuria) 1, 2, 3, 4
• If ACE inhibitor is not tolerated, the American College of Cardiology recommends using an ARB as alternative 1, 2, 3, 4

Medication Monitoring and Adjustments

• The Kidney International journal recommends checking serum creatinine and potassium within 2-4 weeks after initiating or increasing dose of ACE inhibitor/ARB 6
• The American College of Cardiology suggests continuing ACE inhibitor/ARB unless serum creatinine rises >30% within 4 weeks of initiation 6
• The Kidney International journal recommends titrating to highest approved dose that is tolerated, as proven benefits were achieved using target doses in clinical trials 6

Medication Combinations to Avoid

• The American Heart Association, as published in Circulation, advises against combining ACE inhibitor with ARB as this increases risk of hyperkalemia, hypotension, and acute kidney injury without demonstrated benefit 3, 4