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Guidelines for Hypertension

Treatment plan for Hypertension in CKD

  • measure eGFR and ACR
  • measure BP as per British Hypertension Society guidelines

 

Targets (see NICE guidelines)

  • treat if BP > 140/90
  • if CKD with proteinuria or diabetes with microalbuminuria, treat if BP >130/80

 

If systolic BP >180 or diastolic >100

 

If systolic BP >180 or diastolic BP >100:

  • check optic fundi - if haemorrhages or exudates or papilloedema then urgent hospital admission is required
  • if fundi normal then check BP <48 hours and treat as per guidelines

 

General treatment

 

  • Smoking cessation
  • weight loss
  • aerobic exercise
  • limiting alcohol and sodium intake

 

Specific Management Guidelines for Hypertension

 

Treatment plan for Hypertension in CKD with Proteinuria

For patients with CKD and ACR >30, Diabtetes and ACR > 3

 

Step 1 Initiate treatment with ACEi or ARB and titrate to full dose  
    Action to be taken
Step 2 If target BP <130/80 not reached add calcium channel blocker
Step 3 if target BP < 130/80 not reached add thiazide like diuretic
Step 4 If target BP < 130/80 not reached consider alpha or beta blocker or more diuretic
Step 5 If BP persistently > 140/90 on four drugs consider routine referral
    (if ACEi or ARB not suitable consider beta blocker)

 

Treatment plan for Hypertension in CKD with No Proteinuria

 

For patients with CKD and ACR < 30 or Diabetes and ACR < 3

Step 1 If >55 years or Afro-Caribbean initiate Calcium Channel Blocker, otherwise start ACEi or ARB  
    Action to be taken
Step 2 If target BP <130/80 not reached add ACEi or ARB or calcium channel blocker
Step 3 if target BP < 130/80 not reached add thiazide like diuretic
Step 4 If target BP < 130/80 not reached consider alpha or beta blocker or more diuretic
Step 5 If BP persistently > 140/90 on four drugs consider routine referral
    (if ACEi or ARB not suitable consider beta blocker)