Management of hypertension in renal disease

The management of hypertension in renal disease is best understood by classifying patients according to the stage of their chronic kidney disease (CKD). Many of the pathophysiological mechanisms are common to all patients, but in post-transplant recipients there are additional factors to be considered. The benefits of good blood pressure control in CKD are a slowing in the rate of progression of renal disease and a reduction in cardiovascular morbidity and all-cause mortality. In CKD stage 5, the aim is solely to reduce cardiovascular morbidity and mortality; the evidence of benefit here is more controversial, with several studies showing worse outcomes in patients with low blood pressure.