Treatment of arterial hypertension in patients with chronic kidney disease from the perspective of the 2023 European recommendations

Abstract

Hypertension is a common disease in the adult population with an increasing tendency, it leads to damage to target organs, including the kidneys, with the development of chronic kidney disease, and increases the risk of cardiovascular complications and mortality. The paper provides an overview of the European guidelines for the treatment of arterial hypertension, updated in 2023, approved by the European Kidney Association and the International Society of Hypertension, in the context of chronic kidney disease — in comparison with the previous European guidelines (2018) and the current National clinical guidelines (2021). The updated recommendations retain the main provisions of the strategy for the treatment of arterial hypertension with chronic kidney disease of the 2018 European recommendations. Updates have been made to the classification of the main and additional groups of drugs for the treatment of arterial hypertension. For the first time, a new group of “special drugs for the treatment of concomitant pathology” has been added, including three classes of drugs: (1) neprilysin receptor antagonists, (2) sodium-glucose transporter-2 inhibitors, (3) non-steroidal mineralocorticoid receptor antagonists. A step-by-step algorithm for choosing antihypertensive drugs for arterial hypertension depending on the stage of chronic kidney disease has been updated. Recommendations for the treatment of resistant arterial hypertension were covered in detail. Some new recommendations were included for blood pressure targets based on albuminuria levels and other factors. A slightly modified scale for assessing cardiovascular risk in patients with arterial hypertension was presented and the role of chronic kidney disease stages III–V as an independent factor of high or very high cardiovascular risk was confirmed.