© Springer International Publishing AG 2017 127
A. Covic et al. (eds.), Resistant Hypertension in Chronic Kidney Disease,
DOI 10.1007/978-3-319-56827-0_8
Chapter 8
Pathophysiological Insights of Hypertension
in Patients with Chronic Kidney Disease
Faruk Turgut, Mustafa Yaprak, and Faruk Tokmak
Hypertension is present in the vast majority of patients with chronic kidney disease
(CKD) and constitutes a major cardiovascular risk factor for the excessive cardio-
vascular morbidity and mortality in this population [ 1 , 2 ]. The prevalence of hyper-
tension is progressively increasing with the severity of CKD, and control of blood
pressure becomes more difficult with progression of CKD stage [ 3 ]. Hypertension
is also extremely common among hemodialysis or peritoneal dialysis patients and
those who have undergone renal transplantation. Moreover, resistant hypertension
and nocturnal hypertension are observed at higher rates in CKD patients [ 4 , 5 ].
Masked uncontrolled hypertension is also more prevalent among CKD patients [ 6 ].
Furthermore prevalence of hypertension varies with CKD etiology; strong associa-
tion with hypertension was reported in patients with renal vascular disease (93%),
established diabetic nephropathy (87%), polycystic kidney disease (74%), chronic
pyelonephritis (63%), and glomerulonephritis (54%) [ 7 ]. However, patients with
CKD caused by primary glomerular or vascular disease invariably have hyperten-
sion, whereas those with primary tubulointerstitial disease may be normotensive or,
occasionally, salt losing.
Hypertension and CKD are closely associated with an overlapping and inter-
mingled cause and effect relationship. Thus, control of hypertension does not only
reduce cardiovascular risk but also represents an important modifiable factor in
slowing further loss of kidney function. Understanding of the pathophysiology of
F. Turgut (*) • M. Yaprak
Mustafa Kemal University, School of Medicine, Department of Internal Medicine,
Division of Nephrology, Antakya, Hatay, Turkey
e-mail: [email protected]
F. Tokmak
Department of Nephrology, MVZ Gelsenkirchen-Buer, Gelsenkirchen, Germany