Chronic Kidney Disease and Albuminuria in Arterial Hypertension

Chronic kidney disease is a major public health problem worldwide: it is estimated that in the general population, 1 person in 10 has some degree of renal damage. Adequate blood pressure control represents the mainstay of treatment, to delay deterioration of renal function and prevent cardiovascular complications. Current evidence supports a target blood pressure value of 130/80 mmHg or less (ie, <125/75 mmHg) when proteinuria exceeds 1 g/L. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers represent the treatment of choice, especially in the presence of proteinuria. More complete blockade of the renin-angiotensin-aldosterone system (RAAS) has been advocated, using a combination of multiple RAAS blocker drugs or supramaximal doses to maximize renal protection. Achieving recommended blood pressure target values usually requires the use of multiple antihypertensive drugs, including diuretics and calcium channel blockers.