What are the current guidelines for the prescription of antihypertensive medications in patients with chronic kidney disease?
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Current guidelines recommend using renin-angiotensin system inhibitors like ACEIs or ARBs as first-line antihypertensive agents for patients with chronic kidney disease (CKD) and severe albuminuria . These medications have shown superior efficacy in reducing the risk of kidney failure and hospitalization for heart failure in CKD patients with albuminuria . In cases of treatment-resistant hypertension, spironolactone may be added, but its use is limited due to the risk of hyperkalemia . Chlorthalidone, a thiazide-like diuretic, has been found effective in controlling hypertension in CKD patients, potentially allowing for the concomitant use of spironolactone while mitigating the risk of hyperkalemia . Additionally, emerging agents like non-steroidal mineralocorticoid receptor antagonists offer novel strategies for better blood pressure control in CKD patients .
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| Papers (4) | Insight |
|---|---|
| Current guidelines recommend strict blood pressure control (<130/80mmHg) using renin-angiotensin system inhibitors like ARB and ACE inhibitors, calcium channel blockers, SGLT2 inhibitors, ARNI, and mineralocorticoid receptor antagonists. | |
| In chronic kidney disease, guidelines recommend ACEIs or ARBs as first-line, followed by calcium-channel blockers and diuretics. Spironolactone can be added for resistant hypertension, with caution due to hyperkalemia risk. | |
| Current guidelines recommend using RAS-inhibitors as first-line antihypertensive agents in CKD patients with severe albuminuria, based on strong clinical evidence, but suggest considering discontinuation in advanced CKD cases. | |
| Current guidelines recommend angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-2 receptor blockers (ARB) as first-line treatment for hypertension in chronic kidney disease patients, with individualized therapy adjustments. |
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