Table 2 Recommended antihypertensive agents according to the CKD stages and age category

From: Recent advances in the management of secondary hypertension: chronic kidney disease

CKD stage

<75 years

75 years ≤

Diabetes and non-diabetes with proteinuriaa

Non-diabetes without proteinuria

Stages 1–3 [eGFR ≥30 ml/min/1.73 m2]

(1) ACEIs or ARBs

(2) CCBs (high risk of CVD) or thiazide diuretics (fluid retention)

ACEIs, ARBs, CCBs, or thiazide diuretics (fluid retention)

Same as less than 75 years

Stages 4, 5 [eGFR <30 ml/min/1.73 m2]

(1) ACEIs or ARBs

(2) CCBs (high risk of CVD) or loop diuretics (fluid retention)

ACEIs, ARBs, CCBs, or loop diuretics (fluid retention)

CCBs

  1. In CKD stages 4, 5, low dose ACEIs or ARBs are recommended as an initial therapy. If ACEIs or ARBs induce either a worsening of the renal function or hyperkalemia, then CCBs should be used
  2. ACEIs angiotensin-converting enzyme inhibitors, ARBs angiotensin II receptor antagonists, CCBs calcium channel blockers, CVD cardiovascular disease
  3. aProteinuria: urinary protein/Cr ratio of ≥0.15 g/gCr (Clinical Practice Guidelines for Chronic Kidney Disease 2018) [4]
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