%0 Journal Article
%T Hypertension in Chronic Kidney Disease: Navigating the Evidence
%A F. M. Tedla
%A A. Brar
%A R. Browne
%A C. Brown
%J International Journal of Hypertension
%D 2011
%I Hindawi Publishing Corporation
%R 10.4061/2011/132405
%X Hypertension is both an important cause and consequence of chronic kidney disease. Evidence from numerous clinical trials has demonstrated the benefit of blood pressure control. However, it remains unclear whether available results could be extrapolated to patients with chronic kidney diseases because most studies on hypertension have excluded patients with kidney failure. In addition, chronic kidney disease encompasses a large group of clinical disorders with heterogeneous natural history and pathogenesis. In this paper, we review current evidence supporting treatment of hypertension in various forms of chronic kidney disease and highlight some of the gaps in the extant literature. 1. Introduction Hypertension is a major risk factor for cardiovascular and renal disease. Conversely, chronic kidney disease (CKD) is the most common form of secondary hypertension and mounting evidence suggests it is an independent risk factor for cardiovascular morbidity and mortality [1每3]. The prevalence of CKD has been better characterized since the National Kidney Foundation issued a standard classification based on the level of glomerular filtration rate (GFR) and the presence or absence of evidence of renal injury. Patients with stages 1 and 2 CKD need to show evidence of renal injury (e.g., proteinuria), and GFR of ≡90 and 60每89ˋmL/minute, respectively. Stages 3, 4, and 5 correspond to GFR of 30每59, 15每29, and <15 mL/minute, respectively, regardless of any other evidence of renal damage [4]. It is estimated that 10每13% of adults in the USA suffer from some degree of CKD [5]. Evidence from a large number of clinical trials has clearly demonstrated that effective treatment ameliorates the harmful effects of uncontrolled hypertension [6]. Unfortunately, most trials have excluded patients with CKD, and those trials that specifically targeted CKD patients primarily focused on progression of renal disease as the primary clinical endpoint. In this paper, we review the epidemiology, pathophysiology, and therapy of hypertension in CKD and highlight the gaps in the available evidence. 2. Epidemiology Approximately one in three adults in the United States has hypertension [7]. The prevalence of hypertension is higher among patients with CKD, progressively increasing with the severity of CKD. Based on a national survey of representative sample of noninstitutionalized adults in the USA, it is estimated that hypertension occurs in 23.3% of individuals without CKD, and 35.8% of stage 1, 48.1% of stage 2, 59.9% of stage 3, and 84.1% of stage 4-5 CKD patients [8]. Prevalence of
%U http://www.hindawi.com/journals/ijhy/2011/132405/