Key result
Phenotype-oriented management may improve BP control in patients with CKD.
Why the study?
Hypertension is highly prevalent in CKD and substantially contributes to kidney function decline and cardiovascular morbidity, warranting an integrated review of mechanisms, phenotypes, and management.
A phenotype-oriented approach to hypertension in CKD, integrating out-of-office BP monitoring and individualized therapies, is recommended to optimize blood pressure control and mitigate cardiorenal risk.
May inform personalized hypertension strategies in CKD; leaves open need for prospective validation of phenotypes.
Objective: Hypertension is highly prevalent in chronic kidney disease (CKD) and substantially contributes to kidney function decline and cardiovascular morbidity.This review aimed to integrate the pathophysiological mechanisms, clinical phenotypes, diagnostic approaches, and individualized management strategies for hypertension in CKD.Methods: A structured narrative review was conducted through a targeted search of PubMed and Scopus for relevant publications from 2019 to 2026.International guidelines, randomized controlled trials, systematic reviews and meta-analyses, observational studies, and high quality narrative reviews were included according to their clinical relevance, methodological quality, contemporariness, and applicability to hypertension management in adults with CKD.Landmark studies published before 2019 were considered when they provided foundational evidence.Results: Hypertension in CKD results from the interaction of impaired sodium excretion and volume expansion, renin-angiotensin-aldosterone system activation, sympathetic overactivity, and vascular dysfunction.These mechanisms produce heterogeneous clinical phenotypes, including volume dependent hypertension, masked hypertension, nocturnal hypertension, and resistant hypertension.Accurate characterization requires standardized office blood pressure (BP) measurement supplemented by ambulatory or home BP monitoring, assessment of volume status, and evaluation of hypertension-mediated organ damage.Management should combine lifestyle and volume directed interventions with pharmacological therapy tailored to albuminuria, estimated glomerular filtration rate, potassium status, comorbidities, and treatment tolerance.Contemporary options include sodium glucose cotransporter 2 inhibitors, finerenone in eligible patients with type 2 diabetes and albuminuria, chlorthalidone in advanced CKD, and selected device-based therapies.Conclusion: A phenotype-oriented approach that integrates underlying mechanisms with out of office BP assessment and individualized treatment may improve blood pressure control and reduce renal and cardiovascular risk in patients with CKD.
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Laksono et al. (2026) conducted a review in Hypertension in chronic kidney disease. Phenotype-oriented management was evaluated. A phenotype-oriented approach integrating underlying mechanisms with out-of-office blood pressure assessment and individualized treatment may improve blood pressure control in patients with CKD.
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