S 14 Indian Journal of Nephrology

Indian J Nephrol 2005;15, Supplement 1: S14-S22

Clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease (CKD) ypertension is a cause and complications of CKD. Hypertension in CKD increases the risk of important adverse outcomes, including loss of kidney function and kidney failure, early development and accelerated progression of cardiovascular disease (CVD), and premature death. In the ongoing effort to improve outcomes of CKD, the National Kidney Foundation (NKF) Kidney Disease Outcomes Quality Initiative (K/DOQI) appointed a Work Group and an Evidence Review Team in 2001 to develop clinical practice guidelines on hypertension and use of antihypertensive agents in CKD. During this same time, clinical practice guidelines on this topic relevant to CKD were also under development by other organizations, including the Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and the 2003 report of the American Diabetes Association (ADA) on the Treatment of Hypertension in Adults with Diabetes.

target blood pressure.

But several of the drugs like clonidine and prazosin which are commonly used in Indian scenario are not mentioned in these guidelines. Clonidine is very cost effective and useful drug these patients being economical for initial treatment and in those whose blood pressure is refractory to control and require more than 3-4 drugs to achieve the

JNC 7 defines hypertension as systolic blood pressure (SBP > 140mm Hg or diastolic blood pressure (DBP) > 90mmHg, respectively, Although common in CKD, hypertension is not part of the definition of CKD. Table 4 illustrates the classification of individuals based on presence or absence of kidney damage and hypertension

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CKD is defined as kidney damage, as confirmed by kidney biopsy or markers of damage, or glomerular filtration rate (GFR) 3 months Markers of kidney damage include proteinuria, abnormalities on the urine dipstick or sediment examination, or abnormalities on imaging studies of the kidneys. GFR can be estimated from prediction equations based on serum Creatinine and other variables, including age, sex, race, and body size. (Table 1 and 2) Among individuals with CKD, the stage of disease is based on the level of GFR, irrespective of the cause of kidney disease. The high prevalence of earlier stages of CKD emphasizes the importance for all health-care providers, not just kidney disease specialists, to detect, evaluate, and treat CKD.

Hypertension in CKD

Table 1 - Definition of CKD

Copyright © 2005 by The Indian Society of Nephrology

Indian J Nephrol 2005;15, Supplement 1: S14-S22

Clinical practice guidelines for HT in CKD

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Table 2 - Stages and Prevalence of CKD

and level of GFR. Approximately 50% to 75% of individuals with GFR