Antihypertensive therapy in comorbid patients with chronic kidney disease: case report

Arterial hypertension (AH) is a global healthcare problem, being one of the leading risk factors for the development of cardiovascular disease (CVD) and chronic kidney disease (CKD). AH occurs in 30-45% of the adult population and can be both a cause and a consequence of CKD. The pathophysiology of AH associated with CKD includes various mechanisms of high blood pressure (BP), including changes in the renin-angiotensin-aldosterone system (RAAS) activity. Comorbidity of AH and CKD increases the risk of end-stage renal disease (ESRD), cardiovascular and cerebrovascular complications. AH control in patients with CKD helps to reduce this risk and slow the kidney pathology progression. As an initial medicinal therapy in comorbid patients with AH and CKD, a combination of antihypertensive drugs (AHD) should be considered to achieve the target BP level according to modern clinical guidelines for AH. When choosing medications, it is necessary to take into account additional renoprotective and/or cardioprotective effects. The results showed that the combination of angiotensin converting enzyme inhibitors (ACE inhibitors) and calcium channel blockers (CCBs) is most optimal for the treatment of patients with AH and CKD. According to the modern tactics of combination therapy, the indication of AHD fixed-dose combinations (FDCs) is most preferable. This article presents a case study concerning the successful use of ACE inhibitor FDCs and CCBs in a comorbid patient with AH and CKD. KEYWORDS: arterial hypertension, chronic kidney disease, case study, ramipril, amlodipine. FOR CITATION: Ebzeeva E.Yu., Ostoroumova O.D., Doldo N.M. Antihypertensive therapy in comorbid patients with chronic kidney disease: case report. Russian Medical Inquiry. 2023;7(7):418–423 (in Russ.). DOI: 10.32364/2587-6821-2023-7-7-3.