The relationship between hypertension and the kidneys is extremely complex; it can be both a causative factor in kidney disease and a consequence of chronic kidney disease. Therefore, it is important to think about hypertension in a more complex way, especially for young people with hypertension, a family history of kidney disease or diabetes. Diagnosing hypertension is only the first step in a long journey, how to manage your blood pressure is the most critical part. We recommend you an article that tells you the core knowledge that people with kidney disease and hypertension must have. Hypertension and kidney disease are causally related to each other, both primary kidney disease and secondary kidney pathology can cause hypertension; and hypertension is both a key risk factor for the progression of chronic kidney disease and an independent risk factor for cardiovascular events. Active control of hypertension can delay the progression of CKD, protect renal function, and reduce the risk of cardiovascular events. Clinically, are you clear about these issues when managing hypertension in chronic kidney disease? How to identify hypertensive nephropathy and nephropathic hypertension? The history of hypertension in patients with hypertensive nephropathy is often longer than the history of renal disease, and the appearance of proteinuria is usually preceded by more than 5 years of persistent hypertension; persistent proteinuria (24-hour quantification is often < 2 g), with fewer formed fractions on microscopy; renal function tests suggesting that tubular damage is greater than, or precedes, glomerular damage; and renal biopsy is consistent with hypertension-induced small arteriolar sclerosis. What are the common drugs for hypertension in chronic kidney disease? The main therapeutic drugs for hypertension in patients with CKD are: angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor antagonists (ARBs), calcium channel antagonists (CCBs), diuretics, beta-blockers, and alpha-blockers. What medications can induce or exacerbate hypertension? Nonsteroidal anti-inflammatory drugs; oral contraceptives; sympathomimetics; saline corticosteroids; glucocorticoids; erythropoietin; cyclosporine, tacrolimus; vascular endothelial growth factor inhibitors; prohibited drugs; herbal medications. When to start antihypertensive therapy? Once a diagnosis of hypertension is established (i.e., blood pressure > 140/90 mmHg), it is recommended that antihypertensive medications be initiated along with lifestyle modification in patients with CKD, regardless of whether they have comorbid diabetes mellitus.Antihypertensive medications should be initiated in the elderly 60-79 years of age with a blood pressure of > 150/90 mmHg, and can be initiated in the elderly ≥ 80 years of age with a blood pressure of > 150/90 mmHg. What is the goal of blood pressure control in CKD patients? Different guidelines have different blood pressure targets for antihypertensive treatment, especially for patients without urinary protein or diabetes mellitus. The Chinese Guidelines for the Management of Renal Hypertension recommend that CKD patients should have a blood pressure goal of <140/90 mmHg, or ≤130/80 mmHg in cases of overt proteinuria (i.e., urinary albumin excretion of >300 mg/24h). What is the goal for blood pressure control in special populations? CKD patients with diabetes mellitus should have a blood pressure goal of < 140/90 mmHg; if tolerated, the blood pressure goal can be lowered to < 130/80 mmHg; if urinary albumin is ≥ 30 mg/24 h, the blood pressure goal should be ≤ 130/80 mmHg. Elderly patients with CKD between the ages of 60-79 years should have a blood pressure goal of < 150/90 mmHg; if tolerated, the blood pressure goal should be < 140/90 mmHg. 140/90 mmHg. ≥80 years old older patients with CKD have a blood pressure goal of < 150/90 mmHg; if tolerated, this can be lowered to a lower level, avoiding blood pressure <130 60="" 90="">60 years old The goal of controlling blood pressure in patients with CKD can be relaxed to less than 150/90 mmHg. Kidney transplant recipients control blood pressure ≤130/80 mmHg. Should patients with CKD have intensive blood pressure lowering? Intensive blood pressure lowering in CKD patients has both advantages and disadvantages: it can reduce the risk of cardiovascular events and cardiovascular mortality, but the effect on the progression of CKD and the incidence of ESRD is not obvious, and it may lead to hypotension, shock, acute kidney injury and other adverse events. Therefore, antihypertensive treatment must be individualized for CKD patients. For patients with proteinuria, a moderately intensive antihypertensive regimen can be adopted with a view to slowing down the rate of decline in GFR, whereas in the elderly population, blood pressure control needs to be conservative in order to prevent adverse events such as hypotension and stroke. How are antihypertensive drugs chosen? Current guidelines consistently recommend angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists as the first-line antihypertensive agents for patients with CKD. However, combination therapy with RAS blockers and other classes of antihypertensive drugs, such as calcium antagonists and diuretics, is often necessary to achieve adequate blood pressure control. Long-acting drugs, especially those with a long half-life, such as the angiotensin-converting enzyme inhibitor, perindopril, and the calcium antagonist, amlodipine, should be chosen as much as possible to control blood pressure for 24 hours at a time. When is it better to take antihypertensive drugs? Hypertension in patients with renal disease manifests itself as a nocturnal increase in blood pressure, with 42% presenting a nonpareil type and 22% an antipareil type of blood pressure. Taking one or more antihypertensive drugs at bedtime is an economical, simple and effective way to control hypertension in CKD, reduce the risk of adverse events and maintain eGFR in patients with non arytenoid type of blood pressure, without increasing the number of times of medication and drug dosage. What are the precautions when combining medications? Limiting sodium intake (<6 g/d) or adding a diuretic may enhance the antihypertensive and urinary protein-lowering effects of ACEIs/ARBs.Caution should be exercised when combining ACEIs/ARBs with nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase 2 inhibitors, or potassium-sparing diuretics to prevent hyperkalemia. Aldosterone receptor antagonists are potassium-preserving diuretics and should be used in combination with potassium-excreting diuretics, with a high degree of caution when used in combination with AECIs, ARBs, and other potassium-preserving diuretics.CCBs are susceptible to fluid retention, and it is advisable to avoid combining them with other vasodilators. The combination of non-dihydropyridine CCBs with beta-blockers is associated with severe bradyarrhythmias, especially in patients with progressive CKD. What should I be aware of when using an ACEI? Blood potassium, blood creatinine, and estimated glomerular filtration rate (eGFR) should be tested before applying ACEI therapy. Dosing should be started with a small dose and gradually adjusted upward to the standard dose as tolerated by the patient. After 2 to 4 weeks of treatment, the efficacy of the drug should be evaluated and blood potassium, creatinine, and eGFR should be rechecked; if there is an increase in potassium (>5.5 mmol/L), a decrease in eGFR of >30%, or an increase in creatinine of >30%, the dose should be reduced and the patient should be monitored and, if necessary, the drug should be discontinued. Why is hypertension poorly controlled in CKD patients? The main reasons for poor control of hypertension in CKD patients in China are: 1. Medical factors: insufficient use of diuretics, low ratio of combined antihypertensive drug therapy, and irrational antihypertensive drug therapy program. 2. 2.Patient reasons: poor adherence to medication. 3.Refractory causes of renal hypertension: excessive volume load, increase of vasoconstrictive substances, decrease of vasodilatory substances, combination of drugs affecting the effect of antihypertensive drugs, clearance of antihypertensive drugs by dialysis, and combination of other diseases affecting blood pressure control. 4. Lack of public health policy support: lack of early warning mechanism for renal hypertension; lack of integrated community-hospital management; insufficient national essential antihypertensive drugs.