HYPERTENSION IN CKD ANTIHYPERTENSIVES

IN CKD
[Electrolyte & SCr levels: BEFORE
NON-DIABETIC CKD DIABETIC CKD and 1-2 wks AFTER starting]
Target < 140/90 Target < 130/80
 ACEI/ARB
o USED IF DM AND/OR
PROTEINURIA (high dose)
o K and SCr
PROTEINURIA NON-PROTEINURIA  K > 5.6 OR 30% ↑
ACR > 30 mg/mmol ACR < 30 mg/mmol ACEI or ARB in SCr  ↓ or D/C
 retrial at lower
a) If intolerant, switch dose when stable
and hydrated
b) If BP control not  Cautious if K > 5
adequate, use as BEFORE starting
ACEI or ARB ACR 3-30 ACR <3 additional therapy  HCTZ/FUROSEMIDE
o Expect Na and K to ↓
DHP CCB o Switch HCTZ to
ACEI or ANY FIRST LINE
(preferred in proteinuria) furosemide when
ARB ANTIHYPERTENSIVE
and/or eGFR < 30 mL/min
 BETA BLOCKER
ADD THIAZIDE THIAZIDE o Dose adjust hydrophilic
(or loop diuretic if F/O) If BP control not BB (bisoprolol, atenolol)
adequate, use as  ALDOSTERONE ANTAGONIST
additional therapy in o Expect K to ↑
DM w/o nephropathy, or
NON-PROTEINURIA
CVD or CV risk factors  DHP CCB
o Avoid monotherapy
CARDIOSELECTIVE  NON-DHP CCB
COMBO WITH COMBO WITH BETA BLOCKER o Avoid in combo with BB
(or in HF)
OTHERS OTHERS acebutolol, atenolol,
 ALPHA BLOCKERS
bisoprolol, metoprolol
o Not 1st line
or o Used in BPH
LONG-ACTING CCB  VASODILATORS
o Use in combo with BB
and diuretic

Miriam Ahmed