European Society of Hypertension Scientific Newsletter: Update on Hypertension Management

Introduction Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) are recommended as first-line therapy for hypertension in patients with chronic kidney disease (CKD). The relevant evidence extends from background studies showing that blood pressure (BP) reduction with agents that block the renin–angiotensin–aldosterone system (RAAS) yielded greater structural and functional preservation of the kidney to major outcome trials showing that these agents slow CKD progression more effectively than other antihypertensive drugs [1]. However, studies in populations with less advanced nephropathy [2, 3] showed that RAAS-blockers confer no additional benefit compared to other agents and combined RAAS inhibition to increase the risk of acute renal failure [4]. In this report we discuss evidence from trials with hard renal end-points attempting to clarify the value of RAAS blockade for different types of hypertensive patients with CKD.