HYPERTENSION IN CKD

BY SHILPA CHADHA THAKUR

Renal Core Group Member

Hypertension (HTN) and chronic kidney disease (CKD) are similar pathophysiological diseases Chronic hypertension can lead to kidney failure and kidney failure can lead to blood loss pressure (BP). High blood pressure in CKD results from the interaction of many factors, including salt and water retention, increased cellular expansion volume, brain overactivity, activation of the renin-angiotensin system-aldosterone, and endothelial dysfunction However, blood pressure in the CKD population is highly variable and should therefore be carefully monitored.

Diagnosis and management of HTN in CKD have improved over the past decade with increasing evidence As chronic kidney disease (CKD) becomes a global health concern, strategies to slow kidney disease and reduce cardiovascular risk in CKD are important goals in the management of kidney patients. Management of arterial hypertension is important in these patients because blood pressure (BP) is an important determinant of cardiovascular and renal failure Achieving blood pressure targets recommended by international guidelines is imperative and often requires multi-level management, including various medications and lifestyle measures.

Blood Pressure Targets in CKD Patients Blood pressure (BP) targets in CKD patients have been problematic for years This difference is reflected in the latest international guidelines targeting Values [2018 European Society of Hypertension, American College of Cardiology-American Heart Association (ACC/AHA), International Society of Hypertension (ISH), ESC Guidelines for the Prevention of Heart Disease] <140/90 mmHg to <130/80 mmHg as recommended in the KDIGO statement, recently <120/80 mmHg, say new In conclusion, the diagnosis and treatment of hypertension in CKD should be individualized.

Blood pressure should be reduced to at least <140/90 mmHg in all patients A threshold of <130 mmHg is far from the best CV protection and safety and should be considered, especially for young people or protein uric individuals. Blood Pressure Management in CKD Patients In addition to prescribing blood pressure medications, we must also consider the 24-hour blood pressure profile

Although the diagnosis and management of arterial hypertension rely on office blood pressure measurements, patients with CKD have abnormal blood pressure patterns when using out-of-office blood pressure measurements (ABPM) The main observation is that both reduced eGFR and proteinuria are associated with high nocturnal BP and a nonsloping pattern. Some of the mechanisms underlying the elevated nighttime blood pressure values observed in CKD patients are elevated blood pressure, salt sensitivity and volume overload, and sleep deprivation Lifestyle changes are recommended in all hypertension procedures and are considered the first step in hypertension control, even in patients with CKD.

Highlights:

·Very high prevalence of hypertension is seen in India (38.9% women and 45.7% men)

·Hypertension is also prevalent in children and adolescents

·Less than 20% of hypertensive patients have their blood pressure under control

·Indian Hypertension Control Initiative is a multi-stake holder initiative to bring blood pressure levels under control in Indian hypertensive patients

R E S E A R C H

Hypertension is a precursor for many complicated diseases and a person is often remain undiagnosed. A person is said to have hypertension if the blood pressure of a person is ≥140/90 mmHg on at least 2 consecutive measurements. The prevalence of hypertension in India is on the rise. As per the National Family Health Survey-5 (NFHS-5)conducted by the International Institute for Population Sciences, Mumbai under the leadership of the Ministry of Health and Family Welfare, Government of India, 38.9% of women and 45.7% of men in India suffer from mild to severe hypertension. Prevalence is shown to be higher in urban as compared to rural India(Ministry of Health and Family Welfare, n d )

It is not just the adults who suffer from hypertension in India. Based on a recent systematic and meta-analysis of studies in children up to 18 years, 7% of Indian children are hypertensive whereas 12% children are pre-hypertensive. The prevalence of hypertension in children is slightly more in girls and in urban children as compared to boys or rural children respectively. Prevalence of paediatric hypertension has also been demonstrated to have an upwards trend with the highest prevalence in the state of Delhi (11%) followed by Uttar Pradesh and Tamil Nadu (10% each) The lowest prevalence of paediatric hypertension was observed in Rajasthan (1%) and Telangana (3%)(Meena et al., 2021).

Did you know that uncontrolled blood pressure is a high risk for cardiovascular diseases such as heart attack and stroke? Considering the high risk of disease that is attached with hypertension, one would assume that patients with hypertension would be take due care of themselves, consume medication diligently, and adopt appropriate lifestyle modifications to keep blood pressure under control