Hypertension is the leading factor in the global burden of disease. It is the predominant
modifiable risk factor for stroke, heart disease, and kidney failure. Chronic kidney
disease (CKD) is both a common cause and sequel of uncontrolled hypertension. The
pathophysiology of CKD-associated hypertension is complex and multi-factorial. This
paper reviews the key pathogenic mechanisms of CKD-associated hypertension, the importance
of standardized blood pressure (BP) measurement in establishing the diagnosis and
management plus the significance of ambulatory BP monitoring for assessment of diurnal
BP variation commonly seen in CKD. The optimal BP target in CKD remains a matter of
discussion despite recent clinical trials. Medical therapy can be difficult and challenging.
In addition to lifestyle modification and dietary salt restriction, treatment may
need to be individualized based on co-morbidities. Combination of antihypertensive
drugs, including appropriate diuretic choice and dose, is of great significance in
hypertension management in CKD.