Hypertension Management in Chronic Kidney Disease

Hypertension and chronic kidney disease (CKD) are tightly interwoven, each driving the other through shared pathways of vascular injury, nephron loss and maladaptive neurohormonal activation. Effective blood pressure control is central to slowing renal decline, reducing cardiovascular events and preserving quality of life. Management begins with lifestyle measures—sodium restriction, weight optimisation and physical activity—and proceeds to pharmacological therapy tailored to individual risk. Renin–angiotensin system blockade remains the cornerstone, owing to its dual blood pressure–lowering and renoprotective effects. Calcium channel blockers, diuretics and beta-blockers supplement therapy, often in combination, to meet increasingly stringent targets. Emerging agents such as sodium–glucose cotransporter-2 inhibitors and mineralocorticoid receptor antagonists offer additional nephroprotection. Blood pressure goals must balance long-term renal benefit against risk of hypotension, particularly in frail or elderly patients. Special considerations include management during dialysis and after transplantation, where fluid shifts and graft function dictate adjustments in timing and choice of antihypertensives. Across diverse health systems, personalised regimens grounded in systematic monitoring and patient engagement are essential to achieving optimal control and mitigating the global burden of hypertensive CKD.

Research from Nature Portfolio

Recent studies have refined our understanding of how blood pressure influences age-related renal decline. Population-based analysis confirms that systolic pressures and albuminuria are among the leading predictors of faster estimated glomerular filtration rate (eGFR) loss over several years, even when accounting for concurrent cardiovascular markers. These findings underscore the need for early detection of modest protein leakage and tighter systolic control. In a large cross-sectional survey of patients with CKD, high rates of awareness and treatment did not translate into adequate blood pressure control. Fewer than half achieved recommended thresholds of 140/90 mmHg, and even fewer met more stringent targets. Control rates declined with advancing CKD stage, highlighting gaps in home monitoring, combination therapy use and guideline adherence, especially in advanced disease.

Hypertension Management in Chronic Kidney Disease publication trend

The graph below shows the total number of articles in hypertension management in chronic kidney disease across all publications each year (not limited to Nature Index journals).

Technical terms

Chronic kidney disease (CKD): A progressive loss of renal function defined by reduced glomerular filtration rate or evidence of kidney damage over three months or more.

Estimated glomerular filtration rate (eGFR): An approximation of kidney filtration capacity derived from serum creatinine, age, sex and other factors.

Albuminuria: The presence of albumin in urine, indicating glomerular injury and heightened cardiovascular risk.

Renin–angiotensin system (RAS) blockade: Use of ACE inhibitors or angiotensin receptor blockers to attenuate vasoconstriction and reduce intraglomerular pressure.

Antihypertensive combination therapy: Concurrent use of two or more blood pressure-lowering drugs to achieve target pressures when single agents are insufficient.

References

1. Frail hypertensive older adults with prediabetes and chronic kidney disease: insights on organ damage and cognitive performance - preliminary results from the CARYATID study. Cardiovascular Diabetology (2024).
2. Management of Hypertension in Chronic Kidney Disease. Drugs (2019).
3. Distribution of estimated glomerular filtration rate and determinants of its age dependent loss in a German population-based study. Scientific Reports (2021).
4. A nationwide cross-sectional survey on prevalence, management and pharmacoepidemiology patterns on hypertension in Chinese patients with chronic kidney disease. Scientific Reports (2016).