Fast Five Quiz: Renal Impairment From Hypertension

Michael Weber, MD


August 09, 2022

ACEIs or ARBs are the most commonly recommended treatment for patients with hypertension, CKD, and proteinuria, per Herman and colleagues. This form of treatment reduces morbidity and mortality rates in patients with heart failure, patients with recent myocardial infarctions, and patients with proteinuric renal disease. These drugs act primarily through suppression of the renin-angiotensin-aldosterone system. Further, ACEIs prevent the conversion of angiotensin I to angiotensin II and block the major pathway of bradykinin degradation by inhibiting ACE.

Beta blockers are generally not considered a first-line agent for hypertension. However, they can be used when compelling cardiac indications occur, per Alexander and colleagues, and can also be considered in treating young patients with hypertension.

Aldosterone antagonists compete with aldosterone receptor sites, reducing blood pressure (BP) and sodium reabsorption.

Thiazide diuretics are used as monotherapy, or they can be administered adjunctively with other antihypertensive agents. Thiazide diuretics inhibit reabsorption of sodium and chloride mostly in the distal tubules, increase potassium and bicarbonate excretion, and decrease calcium excretion and uric acid retention. Long-term use may result in hyponatremia, particularly in older female patients.

Learn more about the pharmacologic treatment of hypertension.


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