Systematic Review of Refractory Hypertension in Chronic Kidney Disease

Abstract

Background: Resistant hypertension poses a significant challenge in patients with chronic kidney disease (CKD), complicating management and treatment. The prevalence of this condition is difficult to determine due to the potential for reversible causes. Both the renin-angiotensin-aldosterone system and the sympathetic nervous system contribute to its development. Current treatments for hypertension, including medication and lifestyle changes, have limited efficacy in addressing resistant hypertension. Methods: Following PRISMA 2020 guidelines, this systematic review focused exclusively on full-text articles published in English between 2014 and 2024. Result: Over 1,000 publications were screened from the selected databases. After filtering, five relevant studies were identified and subjected to detailed examination. Conclusion: Patiromer, a potassium-binding agent, has been shown to improve cardiovascular outcomes in patients with hypertension and CKD. Phase II trials indicated that patiromer safely facilitates the use of spironolactone and prevents hyperkalemia, which is crucial for patients with heart failure who are resistant to conventional treatments. However, further long-term studies are needed to assess its effects on kidney and heart function. Additionally, renal denervation has shown promising results in lowering blood pressure without adverse effects.