Initiating Early Combination Therapy in Patients with Hypertension and Associated Chronic Kidney Disease: A Narrative Review

Abstract

Hypertension and chronic kidney disease (CKD) are inter-related. Hypertension is both a cause and the consequence of CKD and both these conditions are independent risk factors for cardiovascular disease (CVD). Blood pressure control remains suboptimal in patients with CKD. This needs to be addressed on an urgent basis in order to prevent kidney damage. Combination anti-hypertensive treatment is the need of the hour in CKD patients with hypertension. Hence, the present narrative review was carried out to explore the significance of early combination therapy in the management of patients with hypertension and CKD. A PubMed search was conducted with the search terms ‘hypertension’, ‘chronic kidney disease’ and ‘combination therapy’ for randomized controlled trials, reviews and systematic reviews, published between 2010 and 2020. Abstracts were screened and relevant articles were selected. A search was then conducted on Google Scholar with the same search terms and relevant articles were selected. In a backward chronological search, the reference lists of all the selected articles were checked and more articles relevant to the topic were selected. The selected papers were used to evaluate the role of early combination therapy in patients with hypertension and CKD. Data suggest that combination therapy is needed to manage hypertensive patients with CKD and is indicated in patients with SBP ≥ 20 mmHg or DBP ≥ 10 mmHg above the goal. Initial combination therapy can therefore be considered for patients with hypertension and CKD