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vasculature or is its cause. Patients with CKD have high cardiovascular (CV) morbidity and most often die from CV disease.
The specificity of blood pressure treatment in patients with chronic kidney damage is that good control of hypertension not
only leads to a reduction of CV risk but also to a slowing of the progression of chronic to terminal renal failure.

There is no doubt that the first line of treatment for hypertension in patients with CKD is angiotensin-converting enzyme
inhibitors (ACEi) and angiotensin-2 receptor blockers (ARB). They are recommended especially for those patients with
diabetic nephropathy because, in addition to their antihypertensive effect, they reduce proteinuria, slow down the
progression of chronic kidney failure, especially if given in the early stages of CKD, and reduce CV risk. However, for a long
time, there have been controversial opinions about whether in the advanced stages of renal failure, when the glomerular
filtration rate (GFR) is < 30 mL/min/1.73 m , these drugs should be excluded. According to the latest KDIGO guidelines in
2
2021, renin-angiotensin-aldosterone (RAAS) blockers are the first line in the treatment of proteinuric CKD patients, with
and without diabetes mellitus, and in stage 4, with a note that these drugs should be continued in therapy unless there is
marked hyperkalemia (potassium > 6 mmol/L), acute kidney damage or decrease in estimated glomerular filtration rate >
30%. The most important thing is to individualize the optimal therapy for each patient.

In the guidelines for the treatment of hypertension in patients with CKD, there are no clear recommendations for the
treatment of unregulated hypertension when target pressures cannot be achieved with RAAS blockade and when there
are contraindications for the administration of this group of drugs. The addition of calcium channel blockers, diuretics, and
beta-blockers is based on expert opinion.

Keywords: chronic kidney disease, hypertension, renin-angiotensin-aldosterone blockers

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96 DOI: 10.5937/Galmed2306090S