Current issues in the management and monitoring of hypertension in chronic kidney disease.

PURPOSE OF REVIEW: This review highlights recent developments in the management and monitoring of hypertension in adults with chronic kidney disease (CKD), not on dialysis.

RECENT FINDINGS: Ambulatory blood pressure (BP) monitoring and self-measured BP monitoring can classify abnormal BP patterns better than clinic BP readings. Self-measured BP monitoring lowers BP and allows tailoring of antihypertensive treatment. Dosing of antihypertensive medication at night improves nocturnal hypertension. Recent guidelines recommend a BP target less than 140/90 mmHg for patients with CKD without proteinuria and less than 130/80 mmHg for those with proteinuria. Lower salt intake is associated with a greater effect of renin-angiotensin-aldosterone system blockage in CKD. Lifestyle modification resulting in weight loss reduces BP in individuals with CKD. Of overweight or obese CKD patients, 8% report taking weight loss medication, which is a potential safety concern. Weight loss from intensive lifestyle modification in individuals with diabetes prevents CKD.

SUMMARY: Although we have effective tools to monitor and lower BP, we still need clinical outcome studies to inform BP targets for specific age groups, types of CKD disease, and comorbidities. How to treat obesity to improve hypertension and other comorbidities in patients with CKD remains another important area of research.