Treatment of Hypertension in Chronic Kidney Disease: Does one Size Fit All? A Narrative Review from a Nephrologist’s Perspective

The treatment of hypertension in patients with chronic kidney disease is still controversial, particularly in regards to the intensity of blood pressure lowering. The 2014 guidelines for the management of hypertension in adults released by the Eighth Joint National Committee (JNC 8) have sparked criticism from nephrologists, and various societies have issued differing guidelines. In this article we present a few case vignettes and provide a brief review of the various guidelines, particularly in regards to patients with chronic kidney disease. We review some of the landmark trials that have influenced guidelines and the practice of nephrology, as well as the limitations of the evidence on which the current guidelines are based. We discuss treatment for the patients presented in the case vignettes in light of the guidelines and the evidence. Finally, it will be clear that there is no single BP goal or single drug that is appropriate for all patients, and that our knowledge base for optimal treatment of hypertension in chronic kidney disease is still limited.