Guidelines for the management of hypertension in CKD patients: where do we stand in 2024?

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Paper Summary

Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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New Hypertension Guidelines for CKD Patients in 2024

This review summarizes the 2023 European Society of Hypertension (ESH) guidelines for managing high blood pressure in patients with chronic kidney disease (CKD), highlighting key updates and comparing them with the 2021 KDIGO guidelines. The ESH guidelines offer detailed algorithms for antihypertensive agent selection and address treatment of resistant hypertension in CKD, emphasizing a holistic approach to cardioprotection and nephroprotection.

Possible Conflicts of Interest

Alberto Ortiz is a former Editor-in-Chief of the Clinical Kidney Journal, and Mehmet Kanbay is a member of the journal's Editorial Board. The supplement containing this review was financially supported by the ERA.

Identified Weaknesses

Lack of direct comparison trials

The review highlights the absence of randomized controlled trials directly comparing different blood pressure targets in CKD patients with varying kidney function and albuminuria levels.

Extrapolation of evidence

Recommendations for blood pressure targets in CKD, particularly in patients with diabetes, are often based on extrapolated data from trials in other populations or trials not specifically designed to study kidney outcomes.

Rating Explanation

This is a strong review that provides valuable clinical guidance for managing hypertension in CKD patients. It synthesizes the latest evidence and offers practical algorithms for treatment. While the lack of direct comparison trials and the extrapolation of evidence from other populations are limitations, the guidelines offer a helpful framework for clinical practice.

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