Resistant Hypertension in People With CKD: A Review

Resistant hypertension is common in the chronic kidney disease population and conveys increased risk for adverse cardiovascular outcomes and the development of kidney failure. Recently, the American College of Cardiology and American Heart Association published a revised scientific statement on the...

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Published inAmerican journal of kidney diseases Vol. 77; no. 1; pp. 110 - 121
Main Authors Fay, Kevin S., Cohen, Debbie L.
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 01.01.2021
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Abstract Resistant hypertension is common in the chronic kidney disease population and conveys increased risk for adverse cardiovascular outcomes and the development of kidney failure. Recently, the American College of Cardiology and American Heart Association published a revised scientific statement on the definition and management of resistant hypertension, which codified the long-debated differences between pseudoresistant hypertension and true resistant hypertension. We review this distinction and its importance to nephrologists, who frequently encounter patients for whom antihypertensive therapy fails due to difficulty adhering to complex multidrug regimens. Second, we discuss the evaluation of patients with resistant hypertension, including appropriate screening and diagnostic testing for causes of secondary hypertension. Third, we examine the management of established resistant hypertension, including medication optimization, recent clinical trials supporting lifestyle modifications, and the evidence behind the routine use of mineralocorticoid receptor antagonists. Special attention is given to the vital role of diuretics in the treatment of patients with chronic kidney disease. We propose an algorithm for the diagnosis and management of these cases. Finally, we briefly discuss the current state of antihypertensive device therapies, including kidney denervation and baroreceptor-directed therapies.
AbstractList Resistant hypertension is common in the chronic kidney disease population and conveys increased risk for adverse cardiovascular outcomes and the development of kidney failure. Recently, the American College of Cardiology and American Heart Association published a revised scientific statement on the definition and management of resistant hypertension, which codified the long-debated differences between pseudoresistant hypertension and true resistant hypertension. We review this distinction and its importance to nephrologists, who frequently encounter patients for whom antihypertensive therapy fails due to difficulty adhering to complex multidrug regimens. Second, we discuss the evaluation of patients with resistant hypertension, including appropriate screening and diagnostic testing for causes of secondary hypertension. Third, we examine the management of established resistant hypertension, including medication optimization, recent clinical trials supporting lifestyle modifications, and the evidence behind the routine use of mineralocorticoid receptor antagonists. Special attention is given to the vital role of diuretics in the treatment of patients with chronic kidney disease. We propose an algorithm for the diagnosis and management of these cases. Finally, we briefly discuss the current state of antihypertensive device therapies, including kidney denervation and baroreceptor-directed therapies.
Author Fay, Kevin S.
Cohen, Debbie L.
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  givenname: Debbie L.
  surname: Cohen
  fullname: Cohen, Debbie L.
  email: debbie.cohen@pennmedicine.upenn.edu
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Keywords Hypertension
renal artery stenosis
masked hypertension
blood pressure (BP)
review
fibromuscular dysplasia
resistant hypertension (RH)
chronic kidney disease (CKD)
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Snippet Resistant hypertension is common in the chronic kidney disease population and conveys increased risk for adverse cardiovascular outcomes and the development of...
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SubjectTerms Antihypertensive Agents - pharmacology
blood pressure (BP)
chronic kidney disease (CKD)
Drug Resistance
fibromuscular dysplasia
Humans
Hypertension
Hypertension - complications
Hypertension - therapy
masked hypertension
Medication Therapy Management
renal artery stenosis
Renal Insufficiency, Chronic - complications
Renal Insufficiency, Chronic - physiopathology
resistant hypertension (RH)
review
Title Resistant Hypertension in People With CKD: A Review
URI https://dx.doi.org/10.1053/j.ajkd.2020.04.017
https://www.ncbi.nlm.nih.gov/pubmed/32712185
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