Adults with essential hypertension and coexisting chronic kidney disease — defined by an eGFR below 60 mL/min/1.73 m² or a urine albumin-to-creatinine ratio of 30 mg/g or more — represent a high-risk population in which both blood pressure control and kidney protection guide antihypertensive strategy.
Essential hypertension in the setting of chronic kidney disease with eGFR <60 mL/min/1.73 m² or albuminuria ≥30 mg/g. The combination of elevated blood pressure and impaired kidney function or significant proteinuria substantially increases cardiovascular risk and can accelerate CKD progression.
Treatment in this population is guided by inhibition of the renin-angiotensin-aldosterone system as the cornerstone of first-line antihypertensive therapy — the specific agent class and selection criteria are defined in the full protocol.
Full agent selection, eligibility criteria, and the complete treatment algorithm are available below.
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.
An ACEi or an ARB is recommended for initial treatment of hypertension in CKD due to long-term kidney and CVD benefits in people with moderate or severe albuminuria (≥30 mg/g) and may be considered for those with lower level albuminuria (<30 mg/g) based on expert opinion.