Thread by @Gawad_Nephro

Resistant Hypertension in CKD, How i treat?
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Teaching points from this article are the following thread.
#NephTwitter #CKD #Hypertension #HTN

👉Full link for the article: cjasn.asnjournals.org/content/16/3/4…

👉Apparent resistant hypertension is common in CKD.
👉Assessment for pseudoresistance, including out of office BP monitoring, should be done.
👉Nonpharmacologic measures should be reinforced, along with optimizing pharmacologic therapy.

👉 A long-acting thiazide-like diuretic like chlorthalidone is favored over hydrochlorothiazide because of longer t1/2 and higher potency.

👉 Although it is often the practice to switch to loop diuretics when eGFR is <30 ml/min, there is some evidence that thiazide-like diuretics can still effectively lower BP in advanced CKD

👉 Longer-acting loop diuretics, like torsemide, are favored because of more consistent absorption and advantage of once daily dosiing. Furosemide and bumetanide are short acting and should be dosed at least twice daily.

👉 Losartan has a shorter t1/2, and other agents in this class have better BP-lowering efficacy.

👉 Beta-blockers with vasodilatory effects (like carvedilol or nebivolol) are favored if started for hypertension management

👉 Although there is increasing research interest in devicebased interventions, such as renal denervation and baroreflex amplification therapy, they remain investigational and are not currently FDA approved for clinical use.