Chronic Kidney Disease and Hypertension

A Destructive Combination

Leticia Buffet, PharmD; Charlotte Ricchetti, PharmD, BCPS, CDE

Disclosures

US Pharmacist 

In This Article

Nonpharmacologic Recommendations

Chronotherapy

This type of therapy takes into consideration circadian BP patterns, and institutes administration of antihypertensive medication in respect to the daily patterns, moving away from administration of all antihypertensive medications in the morning. Trials have demonstrated improved 24-hour BP control in patients administering CCBs in the evening rather than in the morning.[31,32] Additional studies have identified benefit from nighttime administration of other antihypertensive medications such as ACE inhibitors or ARBs.[33,34] Chronotherapy may warrant some consideration for those unable to achieve their BP goal when administering all antihypertensive agents in the morning. If patients are on more than two antihypertensive agents, it may be appropriate to administer two agents in the morning and the additional agents in the evening.

Lifestyle Modification

Increased physical activity, weight loss, and dietary modifications are recommended for all patients with HTN.[8] Lifestyle modification remains a critical component of therapy for HTN, regardless of whether patients require medications to achieve their BP goal. The Dietary Approaches to Stop Hypertension (DASH) diet emphasizes an increased consumption of fruits and vegetables, inclusion of low-fat dairy and lean protein, and a restriction of saturated fats; this meal plan has been shown to significantly lower systolic BP nearly equivalent to the reduction achieved by antihypertensive monotherapy.[35] In addition, decreasing sodium and alcohol intake has been established as an effective intervention towards decreasing BP.[8] Initiating these healthy dietary practices while increasing daily activity augments the benefit received from antihypertensive therapy and can play an essential role in achieving BP goals.

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