Etiology and management of hypertension in chronic kidney disease

Hypertension is ubiquitous in the chronic kidney disease. Impaired salt excretion leads to increased extracellular fluid volume and consequent hypertension in renal disease. It is assumed that the excess salt and water retention increases the blood flow to the tissues, which sets in motion the phenomenon of autoregulation. The tissue arterioles vasoconstrict, under the influence of various mediators to decrease the excessive blood flow. The resulting vasoconstriction increases the peripheral vascular resistance, resulting in hypertension. The kidney and central nervous system in integrated manner play role in development of hypertension in chronic kidney disease. Recently, more light has been shed on the multitude of factors and pathophysiologic mechanisms that lead to hypertension in the renal disease. The level of blood pressure is most likely determined by the level of the peripheral vascular resistance and volume status in combination. If the peripheral vascular resistance is not appropriately lowered in the face of hypervolemia, hypertension results. In this review, evidence for the different pathophysiologic mechanisms that have been postulated to explain renal hypertension is presented.