1. Hypertension in Chronic Kidney Disease: Novel Insights.
- Author
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Duni A, Dounousi E, Pavlakou P, Eleftheriadis T, and Liakopoulos V
- Subjects
- Antihypertensive Agents adverse effects, Humans, Hypertension diagnosis, Hypertension epidemiology, Hypertension physiopathology, Kidney physiopathology, Renal Insufficiency, Chronic diagnosis, Renal Insufficiency, Chronic epidemiology, Renal Insufficiency, Chronic physiopathology, Risk Factors, Sympathectomy, Treatment Outcome, Antihypertensive Agents therapeutic use, Blood Pressure drug effects, Hypertension drug therapy, Kidney drug effects, Renal Insufficiency, Chronic drug therapy, Renin-Angiotensin System drug effects
- Abstract
Management of arterial hypertension in patients with chronic kidney disease (CKD) remains a major challenge due to its high prevalence and associations with cardiovascular disease (CVD) and CKD progression. Several clinical trials and meta-analyses have demonstrated that aggressive treatment of hypertension in patients with and without CKD lowers the risk of CVD and all-cause mortality, nevertheless the effects of blood pressure (BP) lowering in terms of renal protection or harm remain controversial. Both home and ambulatory BP estimation have shown that patients with CKD display abnormal BP patterns outside of the office and further investigation is required, so as to compare the association of ambulatory versus office BP measurements with hard outcomes and adjust treatment strategies accordingly. Although renin-angiotensin system blockade appears to be beneficial in patients with advanced CKD, especially in the setting of proteinuria, discontinuation of renin-angiotensin system inhibition should be considered in the setting of frequent episodes of acute kidney injury or hypotension while awaiting the results of ongoing trials. In light of the new evidence in favor of renal denervation in arterial hypertension, the indications and benefits of its application in individuals with CKD need to be clarified by future studies. Moreover, the clinical utility of the novel players in the pathophysiology of arterial hypertension and CKD, such as microRNAs and the gut microbiota, either as markers of disease or as therapeutic targets, remains a subject of intensive research., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)
- Published
- 2020
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