There is a strong association between CKD and an elevated blood pressure (BP) whereby each can cause or aggravate the other. BP control is fundamental to the care of patients with CKD and is relevant at all stages of CKD, regardless of the underlying cause. Reduction in BP, particularly when achieved using agents that interfere with the renin-angiotensin-aldosterone system (RAAS), can lead to acute reductions in kidney function and albuminuria.

In majority of patients with CKD, more intensive BP-lowering is likely to require the addition of at least one new antihypertensive agent. Multiple trials have shown the benefits of BP control in patients with renal disease. These benefits include slowing the progression of CKD and reducing cardiovascular (CV) outcomes and mortality. Patients with diabetic nephropathy or proteinuria particularly benefit from pharmacological blockade of the renin-angiotensin system (RAS) with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).

Among the many antihypertensive agents, ARBs are the most tolerated and have well-known renoprotective effects. Azilsartan appears to be more efficacious in reducing BP, as compared to the maximum doses of three other ARBs (valsartan, olmesartan and candesartan) with a similar safety and tolerability profile along with possible renoprotection. Recent studies in hypertensive patients demonstrated that azilsartan treatment brought about a more significant and persistent reduction in BP for 24 hours than other ARBs. It also changed the non-dipper pattern of BP (nocturnal hypertension) into a dipper pattern more effectively than candesartan. These findings suggested that azilsartan could improve the circadian rhythm of BP.