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Hypertension and Renal Disease
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Salt Sensitivity
Patients with CKD are often salt-sensitive, worsening hypertension. Management includes reducing salt intake, often to less than 2 grams of sodium per day.
Lifestyle Factors
Lifestyle factors such as obesity, smoking, and sedentary lifestyle can contribute to hypertension and CKD progression. Management strategies include weight loss, smoking cessation, and increased physical activity.
Proteinuria
Proteinuria is both a marker and mediator of kidney damage in hypertension. Management involves controlling blood pressure and using ACE inhibitors or ARBs to reduce protein excretion.
Hypertensive Retinopathy
Hypertensive retinopathy indicates end-organ damage which may correlate with kidney disease. Management includes strict blood pressure control.
Blood Pressure Targets in CKD
Aiming for a blood pressure target below 130/80 mmHg is recommended for most patients with CKD. Management strategies involve individualized medical therapy and lifestyle modifications.
Secondary Hypertension
Kidney disease can cause secondary hypertension, which may worsen renal outcomes. Managing the underlying kidney disease and controlling blood pressure are crucial.
Systemic Hypertension
Chronic kidney disease (CKD) can be both a cause and a result of hypertension. Manage with lifestyle changes, medications (ACE inhibitors or ARBs), and blood pressure monitoring.
Volume Overload
CKD patients with hypertension often have difficulty managing fluid balance, leading to volume overload. Management includes diuretics and sodium restriction.
Hypertensive Urgency/Emergency
In CKD, severe elevations in blood pressure may lead to a hypertensive urgency or emergency. Requires immediate management with IV medications and close monitoring.
Renin-Angiotensin-Aldosterone System (RAAS)
Overactivity of RAAS can lead to hypertension and exacerbate kidney damage. Management includes using RAAS inhibitors like ACE inhibitors or ARBs.
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