Summary
In patients with chronic kidney disease, an impaired capacity of the kidney to excrete
sodium is a major contributor to hypertension. We discuss the role of sodium restriction
and diuretic therapy for resistant hypertension in chronic kidney disease. Independent
of increasing blood pressure, a sustained high sodium intake also may affect the progression
of renal disease adversely. Consequently, dietary sodium restriction and appropriate
diuretic therapy are the foundation for the treatment of resistant hypertension. Thiazide-like
diuretics have decreasing effectiveness in patients with advancing renal disease;
however, they may augment the effectiveness of the more potent loop diuretics. Increasing
evidence suggests that spironolactone is an effective adjunct for the treatment of
resistant hypertension. Inclusion of other classes of antihypertensive agents to the
treatment regimen generally is necessary to counterbalance other mechanisms contributing
to resistant hypertension. The effectiveness of these agents is enhanced by dietary
sodium restriction and diuretic therapy.
Keywords
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Article info
Footnotes
☆Financial disclosure and conflict of interest statements: none.
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© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
