Definition, identification and treatment of resistant hypertension in chronic kidney disease patients

Yelena R. Drexler, Andrew S. Bomback

Research output: Contribution to journalReview article

11 Scopus citations

Abstract

Resistant hypertension, the inability to achieve goal blood pressure despite the use of three or more appropriately dosed antihypertensive drugs (including a diuretic), remains a common clinical problem, especially in patients with chronic kidney disease (CKD). While the exact prevalence and prognosis of resistant hypertension in CKD patients remain unknown, resistant hypertension likely contributes significantly to increased cardiovascular risk and progression of kidney disease in this population. We review the identification and evaluation of patients with resistant hypertension, including the importance of 24-h ambulatory blood pressure monitoring in the identification of 'white-coat', 'masked' and 'non-dipper' hypertension, the latter of which has particular clinical and therapeutic importance in patients with resistant hypertension and CKD. We then discuss treatment strategies for resistant hypertension that target the pathophysiologic mechanisms underlying resistance to treatment, including persistent volume excess, incomplete renin-Angiotensin-Aldosterone system blockade and inadequate nocturnal blood pressure control. Finally, we propose a treatment algorithm for evaluation and treatment of resistant hypertension in patients with CKD.

Original languageEnglish (US)
Pages (from-to)1327-1335
Number of pages9
JournalNephrology Dialysis Transplantation
Volume29
Issue number7
DOIs
StatePublished - Jul 2014

Keywords

  • Algorithm
  • Chronic kidney disease
  • Resistant hypertension

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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