[Hypertension in chronic kidney failure (the physiopathology, clinical picture and treatment)].

Secondary hypertension in CRF is characterized by particular features; hemodynamics--abnormal high vascular peripheral resistance relative to the cardiac output level; circadian variability--absence of nocturnal physiological BP decline. Hypertension is the main risk factor for renal disease progression, irrespective of the underlying etiology, and is one of the major determinants of the impressive cardiovascular morbidity and mortality seen in uraemic patients (> 50% cases). The atherosclerotic risk and severe retinopathy are more important in CRF hypertension compared to other causes (including essential HTA) at similar BP levels. Treatment targets for renal patients should be less than 130/90 mmHg. The main treatment modality for ESRD hypertension are sodium and water removal through diet, diuretics and dialytic ultrafiltration. Pro's and con's of antihypertensive medication classes are discussed.