Arterial hypertension and chronic kidney disease - is everything under control?

Hypertension is one of the most common diseases that affects the heart and blood vessels. The number of people suffering from chronic kidney disease is increasing, but this disease often remains unrecognized until advanced stages. Kidney diseases can be the causes of arterial hypertension, but this connection is bidirectional and hypertension often leads to the development of chronic kidney disease. Of the non-pharmacological measures, dietary Na+ restriction is particularly effective, while pharmacological treatment of arterial hypertension in these patients should be started with renin–angiotensin system blockers. Second-line therapy may include either a long-acting dihydropyridine calcium channel blocker or diuretics, while third-line therapy is a combination of all three classes of drugs. The thiazide-like diuretic chlorthalidone is effective and can also be used in patients with advanced renal disease and uncontrolled hypertension, as well as in the treatment of resistant hypertension. Sodium-glucose cotransporter type 2 inhibitors and finerenone, although not registered as antihypertensive drugs, have this effect, and also improve renal and cardiovascular function, as well as outcomes of patients with albuminuria. Renal denervation is one of the treatment options for uncontrolled hypertension, but its effect on patients with advanced kidney disease has not yet been sufficiently studied.