Resistant Hypertension in Chronic Kidney Disease (CKD): Prevalence, Treatment Particularities, and Research Agenda

AbstractPurpose of ReviewTo explore the prevalence, treatment particularities, and research agenda in the management of resistant hypertension among patients with chronic kidney disease (CKD).Recent FindingsThe prevalence of resistant hypertension is reported to be 2 –3 times higher in patients with CKD than in the general hypertensive population. Based in part on the results of the PATHWAY-2 trial showing add-on spironolactone to be superior to placebo or active treatment with an α- or β-blocker in reducing BP, international guidelines recommend the use of spironolactone as fourth-line agent in pharmacotherapy of resistant hypertension. Despite the several-fold higher burden of resistant hypertension among patients with stage 3b–4 CKD, the use of spironolactone in this population has been restricted, mainly due to the risk of hyperkalemia. The recen tly reported AMBER trial showed that among patients with uncontrolled resistant hypertension and an estimated glomerular filtration rate of 25–45 ml/min/1.73m2, the newer potassium-binder patiromer prevented the development of hyperkalemia and increased the proportion of participants who remained on add-on spironolactone over 12  weeks of follow-up. Administration of spironolactone was associated with a clinically meaningful reduction of 11–12 mmHg in unattended automated office systolic blood pressure (BP) over the course of the AMBER trial.SummaryNewer potassium-binding therapies overcome the barrier of hyperkalemi...
Source: Current Hypertension Reports - Category: Primary Care Source Type: research