Recent Controversies Over the Diagnosis and Treatment of Hypertension – Nephrological Perspective

Abstract

Recent controversies over the diagnosis and treatment of hypertension (HT) are reviewed from nephrological perspective. In 2017 American College of Cardiology (ACC) and American Heart Association (AHA), on behalf of 11 societies, presented Guidelines for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, which lowered the threshold from >140/90 mm Hg to >120/80 mm Hg. The lowered threshold value caused an increase of HT in the U.S. by 31.1 million people (from 72.2 to 103.3 million). ACC/AHA guidelines advice self-measuring blood pressure (SMBP) after 5 min rest as superior to office-measured blood pressure. All organisations advice taking a mean of repeated measurements as a proper BP. The only exception is National Institute for Health and Clinical Excellence which reasonably recommends taking the lowest reading as the proper value of BP. Too intensive lowering of BP in cardiovascular high risk population may be beneficial for heart diseases and lower mortality, but may increase risk of AKI, which may contribute to progressive CKD and end stage kidney disease. The optimal BP target for dialysed patients is unknown but it is generally accepted that overhydration is the most important factor in the pathogenesis and treatment of hypertension in dialysed patients. It was proven that proper ultrafiltration and/or frequent hemodialysis allow for better control of blood pressure. Hypertension in renal transplant recipients increases cardiovascular morbidity and mortality and shortens allograft survival. In kidney diseases a personalized approach to the treatment of HT should be advised, starting from inhibitors of the renin–angiotensin system, unless there is indication for the other group of hypotensive drugs.