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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EThis article discusses the critical need to control blood pressure (BP) for patients with chronic kidney disease, issues in diagnosis and management, and specific issues in patients with end-stage renal disease.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertension \u0026amp; Kidney Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ECardiology \u0026amp; Cardiovascular Medicine\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertension \u0026amp; Kidney Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EHypertensive Disease\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERenal Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn a session at the Joint Meeting of the European Society of Hypertension and International Society of Hypertension on hypertension in chronic kidney disease (CKD), a panel of experts discussed the critical need to control blood pressure (BP) for patients with CKD, issues in diagnosis and management, and specific issues in patients with end-stage renal disease (ESRD).\u003C\/p\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ECHANGING EPIDEMIOLOGY OF CKD: INCREASING NUMBER OF PEOPLE WITH UNCONTROLLED BP AT RISK OF DEVELOPING CKD AND ESRD\u003C\/h2\u003E\n         \u003Cp id=\u0022p-3\u0022\u003ERoland E. Schmieder, MD, Professor of Internal Medicine, Nephrology, and Hypertension, University Hospital Erlangen, Erlangen, Germany, opened the session with an overview of the changing epidemiology of CKD in the general population. He highlighted that hypertension and diabetes are the major contributors to the increasing prevalence of CKD, causing up to 60% of cases of CKD in 2014. Hypertension is the primary contributor to progressive disease, he said, indicating that better BP control is critical to slowing down the increasing incidence of ESRD. Data from the Framingham Offspring study showed that the lifetime risk of developing ESRD in the general population was 9.4% [Drev N et al. \u003Cem\u003EAm J Kidney Dis\u003C\/em\u003E 2003] and that the incidence increased with advancing age, diabetes, hypertension, smoking, obesity, and a lower baseline glomerular filtration rate (GFR).\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003ETo reduce the incidence of ESRD and to better manage patients with CKD, patients who are at high risk of developing renal and cardiovascular disease need to be identified. Two tools\u2014estimated GFR (eGFR) and urine albumin-to-creatinine ratio (UACR)\u2014were reviewed and described as having strong predictive power to identify patients with CKD at high risk. Data show that eGFR and UACR were multiplicatively associated with risk of all-cause and cardiovascular mortality, with eGFR \u0026lt;60 mL\/minute\/1.73 m\u003Csup\u003E2\u003C\/sup\u003E and UACR \u0026gt;1.1 mg\/mmol (10 mg\/g) as independent predictors of mortality risk in the general population [Chronic Kidney Disease Prognosis Consortium. \u003Cem\u003ELancet\u003C\/em\u003E 2010].\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EDr. Schmieder emphasized that estimation of GFR is essential for both the staging and the management of CKD (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E) [National Kidney Foundation. \u003Cem\u003EAm J Kidney Dis\u003C\/em\u003E 2002]\u003Cem\u003E.\u003C\/em\u003E\n         \u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14631\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14631\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14631\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EImportance of GFR for Appropriate Staging and Management of Chronic Kidney Disease\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EOverall, he stated that better BP control is essential, and he highlighted that despite medical treatment, many patients have persistent uncontrolled BP [Peralta CA et al. \u003Cem\u003EHypertens\u003C\/em\u003E 2005; Hajjar I, Kotchen TA. \u003Cem\u003EJAMA\u003C\/em\u003E 2003]. What is really needed, he concluded, are population-based strategies for prevention.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-2\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EBP TARGETS IN PATIENTS WITH CKD\u003C\/h2\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EG\u00e9rard London, MD, Centre Hospitalier Manh\u00e8s, Fleury-M\u00e9rogis Cedex, France, spoke on appropriate BP targets in patients with CKD based on the clinical practice guidelines developed by the Kidney Disease Improving Global Outcomes (KDIGO) [KDIGO. \u003Cem\u003EKidney International Supplements\u003C\/em\u003E 2012] He first described the process of generating and grading the recommendations as shown in \u003Ca id=\u0022xref-table-wrap-2-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T2\u0022\u003ETable 2\u003C\/a\u003E.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T2\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14632\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14632\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14632\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 2.\u003C\/span\u003E \n               \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003EFinal Grading of the KDIGO Recommendations\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-14\u0022\u003EGiven the lack of high-quality evidence for most of the issues discussed in the guidelines, he emphasized that most of the recommendations provided are not based on the highest quality of evidence and that many of the guidelines offered only rise to the level of suggestion. \u003Ca id=\u0022xref-table-wrap-3-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T3\u0022\u003ETable 3\u003C\/a\u003E summarizes the recommendations based on the best evidence for the management of BP in patients with CKD.\u003C\/p\u003E\n         \u003Cdiv id=\u0022T3\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14633\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14633\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14633\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 3.\u003C\/span\u003E \n               \u003Cp id=\u0022p-15\u0022 class=\u0022first-child\u0022\u003ERecommendations Based on the Best Evidence for Blood Pressure Management in Chronic Kidney Disease\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-3\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EDEGREE OF RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM BLOCKAGE IN HYPERTENSIVE PATIENTS WITH CKD\u003C\/h2\u003E\n         \u003Cp id=\u0022p-20\u0022\u003EPantelis A. Sarafidis, MD, Senior Lecturer and Honorary Consultant in Nephrology, Department of Nephrology, Hippkoration Hospital, Aristotle University, Thessaloniki, Greece, spoke on the degree of renin-angiotensin-aldosterone system (RAAS) blockade in hypertensive patients with CKD. \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E illustrates the role of the RAAS on renal disease.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/18\/25\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Angiotensin II and Kidney Injury\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1090345443\u0022 data-figure-caption=\u0022Angiotensin II and Kidney Injury\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/18\/25\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/18\/25\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/18\/25\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14630\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-21\u0022 class=\u0022first-child\u0022\u003EAngiotensin II and Kidney Injury\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003ECTGF=connective tissue growth factor; GFR=glomerular filtration rate; PAI-1=plasminogen activator inhibitor-1; TGF-\u03b2=transforming growth factor-beta.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from PA Sarafidis, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-22\u0022\u003EDr. Sarafidis then described clinical data on the effect of RAAS inhibition on renal protection, highlighting that the benefit of RAAS inhibition is mainly in patients with proteinuric nephropathies or those with diabetes and microalbuminuria (\u003Ca id=\u0022xref-table-wrap-4-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T4\u0022\u003ETable 4\u003C\/a\u003E) [Sarafidis P et al. \u003Cem\u003EAm J Kidney Dis\u003C\/em\u003E 2007].\u003C\/p\u003E\n         \u003Cdiv id=\u0022T4\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/14634\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/14634\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/14634\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 4.\u003C\/span\u003E \n               \u003Cp id=\u0022p-23\u0022 class=\u0022first-child\u0022\u003EMajor Randomized Clinical Trials on Renoprotective Effect of RAAS Inhibition\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-30\u0022\u003EAlthough data show that renin-angiotensin system (RAS) blockers reduce progression of typical diabetic neuropathy from normo- to microalbuminuria and from micro- to macroalbuminuria, he stated that no specific agents are indicated in patients with diabetes, normoalbuminuria, and other causes of reduced eGFR (particularly in elderly patients). He also noted that elderly people are underrepresented in these clinical trials, and he emphasized the need to consider this. Specifically, RAS blockers and diuretics may increase the risk of prerenal acute renal failure in elderly persons\u2014including other predisposed patients, such as those with renal arterial lesions or heart failure or those using radiocontrasts or nonsteroidal anti-inflammatory drugs\u2014and that may translate into progression of CKD. For patients without diabetes and nonproteinuric CKD, he said that RAS inhibition and use of diuretics should be individualized, with close follow-up of renal function.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-4\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003EDIAGNOSIS AND MANAGEMENT OF HYPERTENSION IN ESRD PATIENTS\u003C\/h2\u003E\n         \u003Cp id=\u0022p-31\u0022\u003ECarmine Zoccali, MD, Riuniti Hospital, Reggio Calabria, Italy, spoke on the diagnosis and management of hypertension in ESRD patients and the complex relationship between BP and outcomes in this population. Given the dips in BP in this population because of the differences in pre- and postdialysis BP, he clarified that hypertension in these patients mainly depends on volume expansion and that correcting fluid overload by long dialysis sessions in these patients reduces BP.\u003C\/p\u003E\n         \u003Cp id=\u0022p-32\u0022\u003EHe indicated that because of the pre- and postdialysis fluctuations in BP based on fluid status, the use of the gold standard 24-hour BP monitoring is not reliable in this population. Instead, evidence from a joint position statement by the American Society of Hypertension and American Society of Nephrology supports estimating a first-time BP at 44 hours between 2 dialysis sessions with a new threshold for defining hypertension as 135\/88 mm Hg (Agarwal R et al. \u003Cem\u003EJ Am Soc Nephrol\u003C\/em\u003E 2014). If only home monitoring is available, the guidelines recommend 48-hour monitoring, with hypertension defined as \u0026gt;140\/90 mm Hg. He said that home monitoring is a good surrogate and is associated with better ambulatory BP monitoring than capturing pre- and posthemodialysis BP; furthermore, it tracks changes in BP evoked by reduction in body fluids, and it is more reproducible than pre- and posthemodialysis BP.\u003C\/p\u003E\n         \u003Cp id=\u0022p-33\u0022\u003EAmong the interventions that he described to manage BP in this population was the use of ultrafiltration (UF) intensification, with evidence showing that UF intensification with constant dialysis duration reduces BP [Agarwal R et al. \u003Cem\u003EHypertension\u003C\/em\u003E 2009]. However, other data suggesting that UF intensification may increase adverse events in these patients [Curatola G et al. \u003Cem\u003EJ Nephrol\u003C\/em\u003E 2011] indicate the need for more thorough assessment via adequately powered studies to assess safety.\u003C\/p\u003E\n         \u003Cp id=\u0022p-34\u0022\u003EReducing BP lowers cardiovascular risk in these patients, he said, but there is no evidence of pleiotropism by RAS blockade in these patients. Overall, he said that beta-blockade confers superior cardioprotection compared to angiotensin-converting-enzyme inhibition in these patients.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-5\u0022\u003E\n         \u003Ch2 class=\u0022\u0022\u003ESESSION SUMMARY\u003C\/h2\u003E\n         \u003Cp id=\u0022p-35\u0022\u003EIn sum, the increasing prevalence of CKD and ESRD relates to the increasing prevalence of risk factors, such as hypertension and diabetes, and suboptimal risk factor control. RAAS blockade improves renal outcomes in patients with proteinuric nephropathies or those with diabetes and microalbuminuria. In those who have progressed to ESRD, BP typically reflects volume status. As such, a standardized approach to measurement and management of BP must take into account the time in relation to volume removal via dialysis or UF.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2014 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/18\/25.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzp1jd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzp1jd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzp1jd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}