International Journal of Nephrology and Renovascular Disease (Jul 2020)
Practical Strategy for Treating Chronic Kidney Disease (CKD)-Associated with Hypertension
Abstract
Daisuke Nagata, Erika Hishida, Takahiro Masuda Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Tochigi, JapanCorrespondence: Daisuke Nagata Tel +81 285 58 7346Fax +81 285 44 4869Email [email protected]: When renal function declines, blood pressure rises, which in turn causes the kidneys to deteriorate. In order to stop this vicious cycle, it is necessary to lower the blood pressure to a “moderate” level in patients who have chronic kidney disease (CKD)-associated hypertension. Such optimization is problematic, since tight control of blood pressure might worsen the prognosis in elderly patients with CKD, especially those with advanced arteriosclerosis. Although renin-angiotensin system (RAS) inhibitors, angiotensinogen converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) are first-line drugs for hypertensive patients with diabetes, they should be used with caution depending on the patients’ conditions. Recently, there has been a focus on the preventive effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors, anti-diabetic drugs that have been shown to have an impact, on heart and kidney complications. SGLT2 inhibitors increase the amount of sodium chloride delivered to the macular densa of the distal tubules and correct glomerular hyperfiltration by contraction of afferent arterioles via the tubule-glomerular feedback system. It might be one of the reasons why SGLT2 inhibitors show the renal- and cardio-protective effects; however, the mechanism behind their function remains to be elucidated.Keywords: chronic kidney disease, CKD, hypertension, atherosclerosis, intensive blood pressure control, renin-angiotensin system inhibitors, RAS inhibitors, sodium-glucose cotransporter 2 inhibitors, SGLT2 inhibitors
