First-Line Blood Pressure Management in Autosomal Dominant Polycystic Kidney Disease
Clinical Scenario
This protocol addresses the management of elevated blood pressure in people with autosomal dominant polycystic kidney disease (ADPKD). Sustained blood pressure control is a central treatment goal across all affected age groups and CKD stages.
Treatment Approach
First-line management integrates healthy dietary and lifestyle modifications — including reduction of dietary sodium and optimisation of body weight through diet and regular exercise — with renin-angiotensin system (RAS) inhibition. The full protocol defines agent selection and the individualised steps that follow.
Complete regimen details, agent sequencing, and individualised criteria are available in the structured protocol.
Blood Pressure Targets
- Adults aged 18–49 years with CKD G1–G2: target BP ≤110/75 mm Hg (if tolerated, measured by home BP monitoring)
- Adults aged ≥50 years with any CKD stage: target mean systolic BP <120 mm Hg (if tolerated, by standardised office measurement)
References
DOI: 10.1016/j.kint.2024.07.010
- Healthy dietary and lifestyle interventions should be incorporated into the management of BP in all people with ADPKD.
- For people with ADPKD and high BP, we recommend using renin-angiotensin system inhibitors (RASi) (angiotensin-converting enzyme inhibitor [ACEi] or angiotensin II receptor blocker [ARB]) as first-line treatment to achieve the recommended target BP.
- For people with ADPKD aged 18–49 years with chronic kidney disease (CKD) G1-G2 and high BP (>130/85 mm Hg), we recommend a target BP of ≤110/75 mm Hg, as measured by HBPM, if tolerated.
- For people with ADPKD aged ≥50 years with any stage of CKD (CKD G1-G5), we suggest a target mean systolic blood pressure (SBP) of <120 mm Hg, if tolerated, as assessed using standardized office BP measurement.
View source ↗