Managing Arterial Hypertension in Chronic Renal Failure: Myths, Mechanisms, and Therapeutic Realities.
| Title: | Managing Arterial Hypertension in Chronic Renal Failure: Myths, Mechanisms, and Therapeutic Realities. |
|---|---|
| Authors: | Versaci F; Department of Cardiology, Santa Maria Goretti, 04100 Latina, LT, Italy.; Giamundo DM; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, LT, Italy.; Frati G; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, LT, Italy.; IRCCS NEUROMED, 86077 Pozzilli, IS, Italy.; Di Napoli LF; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, LT, Italy.; Biondi-Zoccai G; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, LT, Italy.; Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, RA, Italy.; Ginghina ER; Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, 04100 Latina, LT, Italy. |
| Source: | Journal of clinical medicine [J Clin Med] 2026 Feb 04; Vol. 15 (3). Date of Electronic Publication: 2026 Feb 04. |
| Publication Type: | Journal Article; Review |
| Language: | English |
| Journal Info: | Publisher: MDPI AG Country of Publication: Switzerland NLM ID: 101606588 Publication Model: Electronic Cited Medium: Print ISSN: 2077-0383 (Print) Linking ISSN: 20770383 NLM ISO Abbreviation: J Clin Med Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: Basel, Switzerland : MDPI AG, [2012]- |
| Abstract: | Hypertension is highly prevalent among patients with chronic kidney disease (CKD), contributing significantly to cardiovascular morbidity and progressive renal decline. This overview explores the intricate pathophysiologic mechanisms driving hypertension in renal insufficiency, including volume overload, renin-angiotensin-aldosterone system (RAAS) activation, sympathetic overactivity, and vascular dysfunction. Diagnostic challenges such as white-coat hypertension and the underuse of ambulatory monitoring are discussed, along with the importance of volume assessment and target organ evaluation. We also emphasize individualized management strategies combining lifestyle modification, pharmacotherapy-including RAAS inhibitors, diuretics, and novel agents-and the growing role of device-based interventions. In particular, renal denervation (RDN) has emerged as a potential adjunctive option for selected patients with resistant hypertension in CKD, with preliminary evidence suggesting blood pressure reduction in selected and carefully studied populations, including dialysis-dependent patients. Special considerations for transplant recipients, elderly individuals, and those on dialysis are highlighted, underscoring the need for nuanced, patient-centered care. Misconceptions surrounding RAAS blockade, dialysis hypotension, and therapeutic inertia are critically appraised. Finally, future directions point to biomarker-driven approaches, digital health integration, and large-scale trials on RDN to refine treatment paradigms. This comprehensive synthesis offers a pragmatic framework for clinicians managing hypertension in CKD, aligning mechanistic insights with emerging evidence and clinical realities. |
| References: | Nephrol Dial Transplant. 2019 Jan 1;34(1):1-4. (PMID: 30541107); Curr Treat Options Oncol. 2024 Nov;25(11):1406-1427. (PMID: 39422794); Yonsei Med J. 2025 Feb;66(2):63-74. (PMID: 39894039); J Am Soc Nephrol. 2015 Jun;26(6):1248-60. (PMID: 25653099); Hypertens Res. 2024 Dec;47(12):3409-3422. (PMID: 39415028); Front Pharmacol. 2020 May 26;11:729. (PMID: 32528285); Kidney Int. 2020 May;97(5):861-876. (PMID: 32278617); Eur Heart J Suppl. 2020 Nov 18;22(Suppl L):L160-L165. (PMID: 33239993); Cureus. 2024 Aug 6;16(8):e66304. (PMID: 39108770); Clin Nutr ESPEN. 2025 Oct;69:711-721. (PMID: 40902850); Biomedicines. 2021 Apr 08;9(4):. (PMID: 33917965); N Engl J Med. 1998 Dec 31;339(27):1957-63. (PMID: 9869666); Am J Kidney Dis. 2010 Mar;55(3):441-51. (PMID: 19962808); Circ Res. 2023 Apr 14;132(8):1050-1063. (PMID: 37053276); Am J Kidney Dis. 2023 Jan;81(1):10-12. (PMID: 36153151); Adv Chronic Kidney Dis. 2019 Mar;26(2):92-98. (PMID: 31023453); Ann Intern Med. 2015 Feb 17;162(4):258-65. (PMID: 25686166); Anatol J Cardiol. 2025 Apr;29(4):152-163. (PMID: 40151850); J Hypertens. 2021 Mar 1;39(3):589-591. (PMID: 33534344); Clin Exp Nephrol. 2022 Mar;26(3):207-215. (PMID: 34748113); Eur Heart J. 2019 Nov 1;40(42):3474-3482. (PMID: 30907413); Electrolyte Blood Press. 2022 Dec;20(2):57-63. (PMID: 36688210); J Hypertens. 2023 Dec 1;41(12):1874-2071. (PMID: 37345492); Cureus. 2022 Jul 20;14(7):e27058. (PMID: 36000139); Clin Diabetes. 2024 Oct 15;42(4):469. (PMID: 39429455); Vasc Health Risk Manag. 2022 May 13;18:375-386. (PMID: 35592729); Am J Transplant. 2005 Nov;5(11):2725-31. (PMID: 16212633); Ann Intern Med. 2021 Sep;174(9):1270-1281. (PMID: 34152826); Am J Kidney Dis. 2023 Jan;81(1):15-24.e1. (PMID: 35709922); Curr Probl Cardiol. 2024 Apr;49(4):102411. (PMID: 38246316); Adv Exp Med Biol. 2017;956:307-325. (PMID: 27873228); Annu Rev Pharmacol Toxicol. 2010;50:439-65. (PMID: 20055710); Kidney360. 2020 Jun;1(6):501-509. (PMID: 33305290); J Hypertens. 2025 Jun 1;43(6):986-992. (PMID: 40079826); Int J Mol Sci. 2024 Dec 11;25(24):. (PMID: 39769057); Biomed Res Int. 2016;2016:9710965. (PMID: 27833921); N Engl J Med. 2020 Dec 03;383(23):2219-2229. (PMID: 33264825); Nephrol Dial Transplant. 2022 Jan 25;37(2):304-310. (PMID: 34109413); J Hypertens. 2020 May;38(5):936-942. (PMID: 31990900); Kidney Med. 2023 Apr 18;5(6):100643. (PMID: 37235039); Int J Cardiol Cardiovasc Risk Prev. 2025 Nov 17;27:200550. (PMID: 41333717); Arch Intern Med. 2000 Mar 13;160(5):685-93. (PMID: 10724055); Cochrane Database Syst Rev. 2021 Jun 24;6:CD010070. (PMID: 34164803); J Gen Intern Med. 2022 Sep;37(12):2948-2956. (PMID: 35239109); Am J Kidney Dis. 2019 Jul;74(1):120-131. (PMID: 30898362); Kidney Int. 2021 Mar;99(3S):S1-S87. (PMID: 33637192); Hypertension. 2023 Jun;80(6):e112-e122. (PMID: 37092336); Zhonghua Xin Xue Guan Bing Za Zhi. 2025 Oct 24;53(10):1119-1125. (PMID: 41139647); High Blood Press Cardiovasc Prev. 2024 Jan;31(1):7-13. (PMID: 38267652); Front Pharmacol. 2023 Feb 13;14:1101068. (PMID: 36860293) |
| Contributed Indexing: | Keywords: hypertension; long-term follow-up; renal denervation; renal failure |
| Entry Date(s): | Date Created: 20260213 Date Completed: 20260213 Latest Revision: 20260216 |
| Update Code: | 20260216 |
| PubMed Central ID: | PMC12897971 |
| DOI: | 10.3390/jcm15031250 |
| PMID: | 41682931 |
| Database: | MEDLINE |
Journal Article; Review