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Table 18.1 Indications, additional benefits, caution, and combined use of the different
antihypertensive drug groups in CKD patients [ 5 ]
Type of drug
Other indications
besides
hypertension
Additional
benefits Caution
Combined
use
RAS blockers
ACEIs and
ARBs
Proteinuria
Heart failure
Post-AMI
Reduction of
intraglomerular
pressure,
reduction of
proteinuria, and
CKD progression
Reduction of
fibrosis and
cardiovascular
remodeling
Hyperkalemia
Monitor kidney function
and K+ after starting
treatment
Use of NSAIDs
Use of COX-2 inhibitors
Combined use with other
RAS blockers
Bilateral renal artery
stenosis
Volume depletion
Diuretics
CCBs
BBs
MR
antagonists
Heart failure
Post-AMI
Reduction of
albuminuria
or proteinuria
Hyperkalemia
Monitor kidney function
and K+ after starting
treatment
Use of NSAIDs
Use of COX-2 inhibitors
ACEIs
ARBs
DRIs Reduction of
albuminuria or
proteinuria
As above
Increased risk of
complications in diabetic
or CKD patients when
combined with ACEIs or
ARBs
Diuretics
CCBs
Diuretics
Thiazides Reduced risk of
hyperkalemia
May aggravate
hyperglycemia
Replace with or add loop
diuretic if GFR <30 ml/
min/1.73 m^2
ACEIs
ARBs
Loop
diuretics
Edema Reduced risk of
hyperkalemia
CCBs
DHP Angina ACEIs
ARBs
BBs
Diuretics
Non-DHP Angina
Supraventricular
tachycardia
Reduction of
intraglomerular
pressure
Reduction of
heart rate
They increase the levels
of CNIs and mTOR
inhibitors
Do not associate with
BBs
ACEIs
ARBs
Diuretics
(continued)
L. Segall