Resumen de Management of hypertension in renal disease
The management of hypertension in renal disease is best understood by classifying patients according to the stage of their chronic kidney disease (CKD). Many of the pathophysiological mechanisms are common to all patients, but in post-transplant recipients there are additional factors to be considered. The benefits of good blood pressure control in CKD 3/4 are a slowing in the rate of progression of renal disease and a reduction in cardiovascular morbidity and mortality. There is evidence that reducing blood pressure to 130/80 mmHg or below will attenuate the rate of progression of the renal disease. In CKD 5, the aim is solely to reduce cardiovascular morbidity and mortality; the evidence of benefit here is more controversial, with several studies showing worse outcomes in patients with low blood pressure. In renal transplant recipients, the benefits of good blood pressure control are to prolong graft survival and reduce cardiovascular morbidity and mortality. Most believe that these patients should be treated according to the guidelines for CKD 3/4. In addition, corticosteroid and calcineurin sparing can play an important role in reducing the incidence of hypertension.
