The Chinese Guidelines for the Management of Renal Hypertension 2016 emphasize the principles of treatment for patients with chronic kidney disease (CKD) combined with hypertension.
1. control blood pressure.
2.Delay the onset of renal decompensation and end-stage renal disease.
3. prevention or delay of cardiovascular disease as well as cardiovascular death.
The timing of initiating antihypertensive therapy in patients with renal hypertension is as follows.
1. Once the diagnosis of hypertension is established (i.e., blood pressure >140/90 mmHg), it is recommended that patients with CKD should initiate antihypertensive drug therapy along with lifestyle modification, regardless of whether they have combined diabetes.
2. Elderly people aged 60-79 years with blood pressure >150/90 mmHg should start antihypertensive drug therapy.
3. Elderly people aged ≥80 years with blood pressure >150/90mmHg should start antihypertensive drug therapy.
Blood pressure measurement points to note
1, within 2 weeks after hemodialysis arteriovenous endovascular fistula, blood pressure measurement is prohibited on the surgical side.
After 2 weeks, blood pressure can be measured on the upper arm of the internal fistula side, but prolonged cuffing of the internal limb for blood pressure monitoring is prohibited.
3. When both upper extremities of a hemodialysis patient are not available for blood pressure measurement, blood pressure of both lower extremities can be measured.
4. When evaluating the office blood pressure of dialysis patients, each patient must record at least 6 pre-dialysis and post-dialysis blood pressures (more than 2 weeks) respectively, and take the average value as the office blood pressure.
Antihypertensive treatment goals for each CKD population
1. General population
The recommended blood pressure control target for CKD patients is <140/90mmHg; in combination with overt proteinuria (i.e. urinary albumin excretion rate >300mg/24h) blood pressure can be controlled at ≤130/80mmHg.
2. Patients with diabetes mellitus
It is recommended that the blood pressure of CKD patients with combined diabetes be controlled at <140/90mmHg; if tolerated, the patient's blood pressure target can be further reduced to <130/80mmHg; the blood pressure can be controlled at ≤130/80mmHg when urinary albumin ≥30mg/24h.
3. Elderly patients
It is recommended that elderly CKD patients aged 60 to 79 years have a blood pressure target of <150/90mmHg, and if tolerated, a blood pressure target of <140/90mmHg; elderly patients aged ≥80 years have a blood pressure target of <150/90mmHg, and if tolerated, it can be lowered to avoid a blood pressure of <130/60mmHg.
4.Hemodialysis patients
Combined with the actual situation in China, it is recommended that SBP<160mmHg before dialysis (including drug treatment status).
5.Patients on peritoneal dialysis
It is recommended that peritoneal dialysis patients control their blood pressure below 140/90mmHg, and the blood pressure control target can be relaxed to below 150/90mmHg for patients aged >60 years.
6.Renal transplant recipients
There is a lack of clear standards for blood pressure control in renal transplant recipients. The KDIGO (Kidney Disease Improvement Global Prognosis Organization) guidelines recommend that renal transplant recipients control blood pressure ≤130/80mmHg.