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Management of Hypertension in Patients with Chronic Kidney Disease.

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      Abstract

      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.

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      Affiliations
      [1 ] Division of Nephrology, Department of Medicine, Sidney Kimmel School of Medicine, Thomas Jefferson University, 833 Chestnut Street, Suite 700, Philadelphia, PA, 19107, USA. seyed.hamrahian@Jefferson.edu.
      Journal
      Curr. Hypertens. Rep.
      Current hypertension reports
      Springer Nature
      1534-3111
      1522-6417
      May 2017
      : 19
      : 5
      28451853
      10.1007/s11906-017-0739-9
      10.1007/s11906-017-0739-9

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