Resistant Hypertension in Chronic Kidney Disease

284

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