This protocol applies to adults with hypertension and concurrent chronic kidney disease — specifically those with an eGFR below 60 mL/min/1.73 m² and albuminuria of at least 30 mg albumin/g creatinine. In this population, the choice of antihypertensive therapy carries meaningful implications for both cardiovascular and renal outcomes.
The patient has hypertension alongside chronic kidney disease with eGFR <60 mL/min/1.73 m² and albuminuria ≥30 mg albumin/g creatinine. This specific combination places them in a higher-risk group where blood pressure management must account for kidney disease progression as well as cardiovascular risk.
First-line management involves a renin-angiotensin-aldosterone system (RAAS) inhibitor — a specific agent class selected on clinical grounds to address both blood pressure and renal disease progression simultaneously. The complete selection criteria, contraindications, and algorithm are in the structured protocol.
The primary treatment goal is a systolic blood pressure (SBP) of <130 mm Hg, to decrease all-cause mortality in this population.
DOI: 10.1161/CIR.0000000000001356
For adults with hypertension and CKD as identified by eGFR <60 mL/min/1.73 m² or albuminuria ≥30 mg albumin/g creatinine, treatment should target an SBP goal of <130 mm Hg to decrease all-cause mortality.
For adults with hypertension and CKD as identified by eGFR <60 mL/min/1.73 m² with albuminuria of ≥30 mg/g, RAASi (either with ACEi or ARB but not both) is recommended to decrease CVD and delay progression of kidney disease.
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