Most people with chronic kidney disease (CKD) have high blood pressure. Treatment of hypertension in patients with CKD is considered critical to prevent CKD progression and related cardiovascular events. However, questions remain about the appropriate BP goal. Most evidence indicates there is no benefit of treating to a goal any lower than 140/90 mm Hg, but there is some suggestion that such a goal may be appropriate for patients with albuminuria. Given recent evidence that a lower goal in patients with diabetes (without CKD) actually increases risk, and the subsequent change in American Diabetes Association guidelines from 130/80 mm Hg
Renal denervation is an emerging and promising new therapy for resistant hypertension. Although 54 percent of all hypertension is “uncontrolled” (1), not all uncontrolled hypertension is considered resistant. The American Heart Association (AHA) definition of resistant hypertension is BP above goal on at least three antihypertensive medications of different classes, one of which is a diuretic, or BP that requires four or more medications to get to goal. Prevalence in the general hypertensive population is relatively low, but resistant hypertension is commonly seen in nephrology offices.
In evaluating a patient with resistant hypertension, it’s important to consider reversible