© Springer International Publishing AG 2017 259
A. Covic et al. (eds.), Resistant Hypertension in Chronic Kidney Disease,
DOI 10.1007/978-3-319-56827-0_16
Chapter 16
Treatment of Hypertension in Light of the
New Guidelines: Salt Intake
Baris Afsar and Alper Kirkpantur
Introduction
Presence of hypertension (HT) is commonly seen in patients with chronic kidney
disease (CKD). Additionally, as kidney function declines, blood pressure (BP) ele-
vation occurs and as BP rises, kidney function deteriorates [ 1 ]. This reciprocal inter-
action between kidney function and BP was observed both in experimental and
clinical conditions. Besides, with advancing CKD, control of BP becomes more
difficult [ 2 ]. Indeed, it can be stated that there is resistance to BP lowering effects of
lifestyle modifications and antihypertensive drugs in CKD patients. The mecha-
nisms of BP elevation and resistance to BP lowering in CKD are many but the exact
causes are still unknown. However, one of the most important factors for resistant
HT in CKD is salt intake. Indeed, nearly 2000 years ago, in ancient China, there is
a statement of suspicion that there is link between renal disease, salt, and hyperten-
sion stated as: “when the pulse is full and hard ... the illness dominates the kidneys
and has its seat therein.” “If large amounts of salt are taken, the pulse will stiffen or
harden” [ 3 ].
A part from increased HT prevalence, resistant hypertension (RHT) is also highly
prevalent in CKD patients. Indeed, overt or incipient CKD has long been considered
one of the most frequent medical causes of RHT [ 4 – 6 ].
In this chapter, we tried to summarize the definition, incidence, pathophysiologic
mechanisms, and studies especially focusing on salt intake and resistant HT in CKD.
B. Afsar (*)
Department of Internal Medicine, Division of Nephrology Çünür, Suleyman Demirel
University, Doğu yerleşkesi, Isparta Merkez/Isparta, 32260, Turkey
e-mail: [email protected]; [email protected]
A. Kirkpantur
Department of Nephrology, Acıbadem University Hospital, Ankara, Turkey