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Devices to Treat Hypertension in Chronic Kidney Disease

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Core Concepts in Hypertension in Kidney Disease

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Abstract

Hypertension is common in chronic kidney disease (CKD), and can be a cause or consequence of CKD. The prevalence of resistant hypertension is reported to be as high as 23 % in CKD, and prevalence increases as the estimated glomerular filtration rate (eGFR) declines. Suboptimal control rates of hypertension and limited advances in pharmacologic options have increased interest in the use of device therapy as potential complementary or alternative treatment modalities for hypertension. However, before routine use of these devices can be recommended for hypertension management, better understanding is needed regarding the safety, efficacy, and durability of their effects. This is especially true in CKD patients, as all large clinical trials studying device therapy have excluded patients with moderate-to-severe CKD and end-stage renal disease on dialysis. Additionally, studies do not show a universal blood pressure-lowering response with device therapy—patient subgroups that are more likely to respond need to be identified, and practical clinical markers that can assess adequacy of the intervention are needed. It should also be noted that none of the device therapies are currently approved for clinical use in the USA. Appropriate evaluation of patients with resistant hypertension, with emphasis on lifestyle modifications and appropriate antihypertensive medication use remains the cornerstone of management of these patients. Close collaboration between internists, interventionalists, and hypertension specialists is essential in the clinical and research arena of resistant hypertension, particularly when designing future research studies with device therapies, and determining their place in the treatment of hypertension.

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  1. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA

    George Thomas MD, FACP

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  1. Global and Continuing Education, Harvard Medical School, Boston, Massachusetts, USA

    Ajay K. Singh

  2. VA Medical Center, Indiana University School of Medicine, Indianapolis, Indiana, USA

    Rajiv Agarwal

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Thomas, G. (2016). Devices to Treat Hypertension in Chronic Kidney Disease. In: Singh, A., Agarwal, R. (eds) Core Concepts in Hypertension in Kidney Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6436-9_14

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