Treatment of Hypertension in Chronic Kidney Disease

Blood Pressure Targets

• The American College of Cardiology recommends that adults with hypertension and CKD should be treated to a BP goal of less than 130/80 mmHg 1, 2, 4
• For patients with moderate-to-severe CKD with eGFR >30 mL/min/1.73 m², a systolic BP target of 120-129 mmHg is recommended if tolerated 3

First-Line Medication Selection

• The American College of Cardiology recommends that for patients with CKD stage 3 or higher OR stage 1-2 with albuminuria, an ACE inhibitor is recommended to slow kidney disease progression 1, 2, 5
• If an ACE inhibitor is not tolerated, an ARB may be used as an alternative 1, 2, 5

Special Considerations for Different Patient Populations

• For kidney transplant recipients, a dihydropyridine calcium channel blocker is recommended as first-line therapy due to improved GFR and kidney survival 1, 6

Important Contraindications and Precautions

• The American College of Cardiology advises avoiding any combination of ACE inhibitor, ARB, and direct renin inhibitor therapy in patients with CKD 3, 6
• Diuretics require careful dosing to avoid fluid retention or volume contraction, which can increase the risk of hypotension and renal insufficiency 3, 4