• Hypertension is commonly seen in patients with chronic kidney disease (CKD)
• The mechanism of hypertension in CKD include volume overload, sympathetic overactivity, salt retention, endothelial dysfunction, and changes in blood pressure regulating hormone systems
• Uncontrolled hypertension is also linked with increased risk for cardiovascular morbidity and mortality

CKD is associated with:

1. Increased activity of the RAAS, reduced blood flow in peritubular capillaries downstream of sclerosed glomeruli
2. Angiotensin II has a direct vasoconstrictor effect, which increases systemic vascular resistance and BP
3. Angiotensin II also enhances sodium reabsorption in the proximal tubule and the collecting duct
4. Sodium retention causes hypertension through volume dependent and volume-independent mechanisms
5. Overactivity of the sympathetic nervous system in CKD stimulates renin production by the renal juxtaglomerular cells. Angiotensin II levels directly stimulate SNS activity
6. Endothelial dysfunction, oxidative stress, and increased endothelin levels are also implicated in the pathogenesis of hypertension in patients with CKD
7. Various factors related to CKD complications may also contribute to the high prevalence of hypertension among patients with CKD

Over time, elevated systemic arterial pressures transmitted to the kidney lead to glomerular hypertension, nephrosclerosis, and progressive loss of kidney function.

It is concluded that multiple mechanisms have been implicated in the development of hypertension in CKD.

Resource:

Ku E, Lee BJ, Wei J, Weir MR. Hypertension in CKD: Core Curriculum 2019. AJKD. 2019; 74:120-31.