According to the National Kidney Foundation, chronic kidney disease (CKD) is a worldwide public health problem affecting nearly 50 million people. More than half of the people who have CKD also have high blood pressure. CKD can cause hypertension and hypertension can cause CKD. All types of blood pressure medications are effective in lowering blood pressure in CKD. Most blood pressure medications help with heart disease and some in particular slow down the loss of kidney function.
ACE Inhibitors and ARBs
Angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARB) cause your arteries to dilate helping the blood flow more smoothly through your veins and arteries. ACEs and ARBs are proven to be effective in lowering blood pressure in CKD. Not only can they lower blood pressure, but they are heart and kidney protective as well. For this reason they are preferred agents for CKD.
Diuretics
Diuretics are commonly referred to as water pills. They can lower blood pressure and flush out excess water and sodium collecting in the body. These medications also add to the positive effects of ACE inhibitors, ARBs, and other blood pressure medications. Taking diuretics can reduce the chance of getting heart disease in CKD.
Beta Blockers and Calcium Channel Blockers
Beta blockers reduce heart rate, making the heart pump blood at a slower rate. This process decreases your blood pressure. Calcium channel blockers (CCBs) dilate arteries and diminish the force of the heart's contractions. This results in blood pumping through the body at a slower rate, thereby reducing blood pressure.
Direct Renin Inhibitors
The renin-angiotensin-aldosterone system (RAAS) has long been recognized to play a significant role in hypertension. Aliskiren, a direct renin inhibitor, is the first in this new class of agents to be approved by the FDA for use in hypertensive patients. It works by modifying the RAAS system and reduces blood pressure. In 2008, the FDA approved aliskiren in combination with hydro-chlorothiazide for the treatment of hypertension. Preliminary research shows that aliskiren may be kidney protective similar to ACE inhibitors and ARBs. The effect on long-term prognosis is unknown. A large trial is currently underway.
If the blood pressure target is not achieved with this treatment alone, preferred agents such as ACE inhibitors and ARBs and diuretics, other agents, such as beta-blockers and CCBs and direct rennin inhibitors may be added.
References
- National Kidney Foundation: Guidelines
- National Kidney Foundation: Hypertension
- New England Journal of Medicine: Aliskerin maybe kidney protective
- Aliskerin effective in treating hypertension. S. Aliskiren: an oral renin inhibitor for the treatment of hypertension. Cardiol Rev. 2007;15:316-323.
