The target blood pressure is less than 130/80 mmHg. Home monitoring of blood pressure is important. Blood pressure is gradually reduced.

In blood pressure control, modification of lifestyle and salt restriction are important. In principle, ACE inhibitors or ARBs is chosen as first-line antihypertensive agent. Combination therapy is necessary to achieve Captisol target blood pressure in the majority of cases. It is better to reduce urinary protein excretion below 0.5 g/g creatinine. The importance of decreasing blood pressure in CKD Hypertension is a cause of CKD and aggravates existing CKD. On the contrary, CKD brings about hypertension

and worsens existing hypertension. A vicious cycle thus arises between the two illnesses. The purpose of blood pressure control is to suppress CKD progression and to prevent or retard the progression to ESKD. Suppression of CKD progression leads to inhibition of development as well as progression of cardiovascular disease (CVD). Hypertension is a potent risk factor for CVD, so that antihypertensive therapy contributes directly to CVD development as well as RXDX-101 its progression. Target blood pressure in CKD Meta-analysis revealed that greater blood pressure reduction results in smaller GFR decline rate (Fig. 18-1). Fig. 18-1 Relationship between achieved blood pressure control and declines in GFR in clinical trials of diabetic and nondiabetic renal disease. Quoted, with modification, from: Bakris et al. Am J Kidney Dis 2000;36:646–661 The target blood pressure in CKD is set at

less than 130/80 mmHg, and if urinary protein exceeds 1 g/day it is set further lower at 125/75 mmHg. Importance of home DNA ligase blood pressure monitoring Home blood pressure monitoring is essential to detect nocturnal and morning hypertension, which are risk factors for progression of CKD. CKD patients are required to measure blood pressure twice a day: (1) within 1 h of waking up in the morning, before breakfast and (2) before going to bed at night. Physicians make use of both home and office blood pressure, which is useful for management of hypertension. Speed of blood pressure lowering Strict blood pressure control is essential for CKD but its rapid attainment has potential to aggravate kidney function and CVD. Blood pressure is gradually decreased in 2–3 months under close observation.