Hypertension Management in African Male Patients with CKD Stage 3a

Recommended Medication Change

• The American College of Cardiology recommends a low-dose angiotensin receptor blocker (ARB) such as losartan as the first-line replacement option for lisinopril in a male African patient with CKD stage 3a, preferably combined with a dihydropyridine calcium channel blocker (DHP-CCB) 1, 2
• The European Heart Journal guidelines suggest considering adding a DHP-CCB to the treatment regimen, as this combination is particularly effective in Black patients for blood pressure control 4, 5

Rationale for ARB Selection

• The European Heart Journal guidelines recommend initial antihypertensive treatment for Black patients to include a diuretic or CCB, either in combination or with a RAS blocker, due to race-specific considerations 4
• RAS blockers, including ARBs, are more effective at reducing albuminuria than other antihypertensive agents and are recommended as part of the treatment strategy in hypertensive patients with CKD, according to the European Heart Journal guidelines 4, 6

Dosing and Monitoring

• The European Heart Journal guidelines recommend monitoring renal function (eGFR, serum creatinine) and blood pressure target: 120-129 mmHg systolic for patients with eGFR >30 mL/min/1.73m² 4, 6
• The American College of Cardiology recommends monitoring blood pressure control within 3 months of medication change 1, 2

Escalation Strategy if BP Control Not Achieved

• The American College of Cardiology recommends increasing the ARB to full dose and adding a dihydropyridine CCB if not already included, as an escalation strategy if blood pressure control is not achieved 1, 2, 3