Management of Hypertension in Patients with Chronic Kidney Disease
Department of Neurological, Nephrological, and Rheumatological Science, Graduate School of Medicine, Nippon Medical School
Chronic kidney disease (CKD) is defined by two criteria. One criterion is abnormal renal function or morphology, especially proteinuria. A second criterion is an estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 calculated with the serum creatinine concentration. CKD is classified on the basis of eGFR from stage 1 to stage 5. CKD is a common cause of cardiovascular disease (CVD). CVD is a major cause of morbidity and mortality in patients with CKD. Management of hypertension in patients with CKD aims to prevent CVD and provide renoprotection. First-line agents for controlling blood pressure are inhibitors of the renin-angiotensin system: angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers. These agents are superior to other classes of antihypertensive agents in reducing the amount of urinary protein and in preserving renal function. In CKD, the target blood pressure is less than 130/80 mmHg, and 125/75 mmHg, if the amount of urinary protein is more than 1 g/day. To achieve the target blood pressure, other classes of antihypertensive agents, such as diuretics and calcium channel blockers, should also be administered.
日医大医会誌 2010; 6(1), 17-22
chronic kidney disease, cardiovascular disease, renin-angiotensin system, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers
Kouichi Utsumi, Department of Neurological, Nephrological, and Rheumatological Science, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan