270
Conclusions
Chronic kidney disease and RHT are closely related with each other and as CKD
progresses, the proportion RHT increases. Although currently the cause and effect
relationship cannot be suggested, studies confirm that there is reciprocal relation-
ship between progression of CKD and development of RHT. The causes of RHT in
CKD are thought to be many but the most important factor is the salt. Indeed the BP
in CKD is salt sensitive. Although studies are rare, recent evidence suggests that salt
intake is closely related with the development of RHT in CKD. Thus reduction of
salt intake (both individually and nationally) is very important. To accomplish this
issue, active education seems mandatory. Prospective, placebo-controlled studies
are needed whether reducing salt intake will translate into heath outcomes including
cardiovascular diseases.
References
- Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, Toto R, Tuttle K, Douglas J, Hsueh
W, Sowers J. Preserving renal function in adults with hypertension and diabetes: a consen-
sus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees
Working Group. Am J Kidney Dis. 2000;36(3):646–61. - Cai G, Zheng Y, Sun X, Chen X. Survey of Prevalence, Awareness, and Treatment Rates in
Chronic Kidney Disease Patients with Hypertension in China Collaborative Group. Prevalence,
awareness, treatment, and control of hypertension in elderly adults with chronic kidney dis-
ease: results from the survey of Prevalence, Awareness, and Treatment Rates in Chronic
Kidney Disease Patients with Hypertension in China. J Am Geriatr Soc. 2013;61(12):2160–7. - Michell AR. Salt, hypertension and renal disease: comparative medicine, models and real dis-
eases. Postgrad Med J. 1994;70(828):686–94. - Drexler YR, Bomback AS. Definition, identification and treatment of resistant hypertension in
chronic kidney disease patients. Nephrol Dial Transplant. 2014;29(7):1327–35. - Sarafidis PA. Epidemiology of resistant hypertension. J Clin Hypertens (Greenwich).
2011;13(7):523–8. - Borrelli S, De Nicola L, Stanzione G, Conte G, Minutolo R. Resistant hypertension in nondi-
alysis chronic kidney disease. Int J Hypertens. 2013;2013:929183. - Calhoun DA, Jones D, Textor S, Goff DC, Murphy TP, Toto RD, White A, Cushman WC,
White W, Sica D, Ferdinand K, Giles TD, Falkner B, Carey RM. Resistant hyperten-
sion: diagnosis, evaluation, and treatment. A scientific statement from the American Heart
Association Professional Education Committee of the Council for High Blood Pressure
Research. Hypertension. 2008;51(6):1403–19. - Judd E, Calhoun DA. Apparent and true resistant hypertension: definition, prevalence and
outcomes. J Hum Hypertens. 2014;28(8):463–8. - Sarafidis PA, Georgianos PI, Zebekakis PE. Comparative epidemiology of resistant hyper-
tension in chronic kidney disease and the general hypertensive population. Semin Nephrol.
2014;34(5):483–91. - Modolo R, de Faria AP, Sabbatini AR, Barbaro NR, Ritter AM, Moreno H. Refractory and
resistant hypertension: characteristics and differences observed in a specialized clinic. J Am
Soc Hypertens. 2015;9(5):397–402. - Sarafidis PA, Bakris GL. Resistant hypertension: an overview of evaluation and treatment.
J Am Coll Cardiol. 2008;52(22):1749–57.
B. Afsar and A. Kirkpantur