Hypertension and chronic kidney diseases

Chronic kidney diseases – arising from inborn or acquired renal disorders – are one of the most common causes of secondary hypertension. Renal parenchymatous hypertension accompanying bilateral or unilateral kidney diseases is more prevalent than renovascular hypertension. The prevalence and severity of hypertension are influenced by age, weight, type of renal affliction, and depth of renal dysfunction. In multifactorial pathogenesis, sodium retention plays the crucial role together with dysbalance concerning effects of different vasoactive substances; however, unequivocal distinction between volume- and renin-type hypertension is difficult. The treatment of renal hypertension includes appropriate lifestyle changes, pharmacotherapy, hemoelimination methods and radiological or urological invasive procedures. In chronic kidney diseases with increased albuminuria or proteinuria, ACE inhibitors and AT1-blockers are preferred. Combination of several antihypertensives is often required to achieve the target blood pressure. Increased blood pressure represents not only the manifestation of chronic kidney diseases but also an important factor concerning the renal and cardiovascular risk.