Hypertension in Chronic Kidney Disease (CKD): Diagnosis, Classification, and Therapeutic Targets

dc.contributor.authorGeorgianos, Panagiotis I.
dc.contributor.authorAgarwal, Rajiv
dc.contributor.departmentMedicine, School of Medicineen_US
dc.date.accessioned2023-04-17T17:15:00Z
dc.date.available2023-04-17T17:15:00Z
dc.date.issued2021
dc.description.abstractBlood pressure (BP) in the office is often recorded without standardization of the technique of measurement. When office BP measurement is performed with a research-grade methodology, it can inform better therapeutic decisions. The reference-standard method of ambulatory BP monitoring (ABPM) together with the assessment of BP in the office enables the identification of white-coat and masked hypertension, facilitating the stratification of cardiorenal risk. Compared with general population, the prevalence of resistant hypertension is 2- to 3-fold higher among patients with chronic kidney disease (CKD). The use of ABPM is mandatory in order to exclude the white-coat effect, a common cause of pseudoresistance, and confirm the diagnosis of true-resistant hypertension. After the premature termination of Systolic Blood Pressure Intervention Trial due to an impressive cardioprotective benefit of intensive BP-lowering, the 2017 American Heart Association/American College of Cardiology guideline reappraised the definition of hypertension and recommended a tighter BP target of <130/80 mm Hg for the majority of adults with a high cardiovascular risk profile, inclusive of patients with CKD. However, the benefit/risk ratio of intensive BP-lowering in particular subsets of patients with CKD (i.e., those with diabetes or more advanced CKD) continues to be debated. We explore the controversial issue of BP targets in CKD, providing a critical evaluation of the available clinical-trial evidence and guideline recommendations. We argue that the systolic BP target in CKD, if BP is measured correctly, should be <120 mm Hg.en_US
dc.eprint.versionFinal published versionen_US
dc.identifier.citationGeorgianos PI, Agarwal R. Hypertension in Chronic Kidney Disease (CKD): Diagnosis, Classification, and Therapeutic Targets. Am J Hypertens. 2021;34(4):318-326. doi:10.1093/ajh/hpaa209en_US
dc.identifier.urihttps://hdl.handle.net/1805/32444
dc.language.isoen_USen_US
dc.publisherOxford University Pressen_US
dc.relation.isversionof10.1093/ajh/hpaa209en_US
dc.relation.journalAmerican Journal of Hypertensionen_US
dc.rightsCC0 1.0 Universal*
dc.rights.urihttps://creativecommons.org/publicdomain/zero/1.0*
dc.sourcePMCen_US
dc.subjectBlood pressureen_US
dc.subjectChronic kidney diseaseen_US
dc.subjectHypertensionen_US
dc.subjectMasked hypertensionen_US
dc.subjectResistant hypertensionen_US
dc.subjectTherapeutic targetsen_US
dc.subjectWhite-coat hypertensionen_US
dc.titleHypertension in Chronic Kidney Disease (CKD): Diagnosis, Classification, and Therapeutic Targetsen_US
dc.typeArticleen_US
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