Clinical Pharmacology of Antihypertensive Therapy for the Treatment of Hypertension in CKD

Clin J Am Soc Nephrol. 2019 May 7;14(5):757-764. doi: 10.2215/CJN.04330418. Epub 2018 Nov 13.


CKD is common and frequently complicated with hypertension both predialysis and in ESKD. As a major modifiable risk factor for cardiovascular disease in this high-risk population, treatment of hypertension in CKD is important. We review the mechanisms and indications for the major classes of antihypertensive drugs, including angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, β-adrenergic blocking agents, dihydropyridine calcium channel blockers, thiazide diuretics, loop diuretics, mineralocorticoid receptor blockers, direct vasodilators, and centrally acting α-agonists. Recent evidence suggests that β-adrenergic blocking agents may have a greater role in patients on dialysis and that thiazide diuretics may have a greater role in patients with advanced CKD. We conclude with sharing our general prescribing algorithm for both patients with predialysis CKD and patients with ESKD on dialysis.

Keywords: Adrenergic beta-Antagonists; Algorithms; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Calcium Channel Blockers; Dihydropyridines; Kidney Failure, Chronic; NR3C2 protein, human; Pharmacology, Clinical; Receptors, Mineralocorticoid; Sodium Chloride Symporter Inhibitors; Sodium Potassium Chloride Symporter Inhibitors; Vasodilator Agents; hypertension; renal dialysis; risk factors.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Antihypertensive Agents / therapeutic use*
  • Calcium Channel Blockers / therapeutic use
  • Humans
  • Hypertension / drug therapy*
  • Renal Insufficiency, Chronic / complications*
  • Sodium Chloride Symporter Inhibitors / therapeutic use
  • Vasodilator Agents / therapeutic use


  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Sodium Chloride Symporter Inhibitors
  • Vasodilator Agents