Advances in Chronic Kidney Disease presents focused review articles devoted to a single topic of current importance in clinical nephrology and related fields. The in-depth scholarly review articles explore the care and management of persons with early kidney disease and kidney failure, as well as those at risk for kidney disease.
Hypertension is a global health problem and without adequate diagnosis and treatment is a risk factor for morbidity and mortality. Proper assessment of blood pressure is key to diagnosis and management of hypertension. Different methods of measurement are available for use and varying techniques are applied to patient care. Understanding the proper methods of blood pressure measurement both in and out of the physician's office is crucial for providing appropriate care to an individual patient. In addition, understanding the techniques used in research, on which current guidelines are based, is critical for proper application to daily practice.
Resistant hypertension is defined as high blood pressure requiring 3 or more medications for adequate control or controlled blood pressure requiring 4 or more medications. Considering the growing prevalence of hypertension and the strong link with cardiovascular disease, it is vital to understand the causes and treatment of resistant hypertension. This review article starts with an overview of the prevalence and little-known pathophysiology of resistant hypertension. Afterward, we discuss the evaluation and management of suspected secondary resistant hypertension in 2 broad categories: pseudoresistant hypertension and true resistant hypertension.
Hypertension is a common condition known to cause significant cardiovascular events including death, stroke, and heart failure.1,2 Our understanding of the pathogenesis and optimal approaches to therapy has evolved tremendously over the past 50 years.3 Despite these advances, only 50% of individuals achieve blood pressure control according to National Health and Nutrition Examination Surveys 2015-2016 data.4 Hypertension remains a significant global health problem, and in this issue of Advances in Chronic Kidney Disease, we have put together a set of manuscripts covering several key issues in both the pathogenesis and management of hypertension.
This issue of Advances in Chronic Kidney Disease features an old standard, hypertension. This topic is reviewed periodically. This time, Dr. Kausik Umanath has taken up the gauntlet to press forward our collective mission to diagnose and treat this most fundamental medical problem early, accurately, and efficiently. In this issue, the variegation of the pathophysiology of hypertension will be revealed along with its treatments. In Dr. Umanath's Guest Editorial, you will see a glimpse of what is contained within, but first, a story.
Early reports of renal denervation as a therapy for hypertension generated intense interest in this approach to management of elevated blood pressures despite ongoing treatment. The publication of the large, sham-controlled randomized clinical trial of renal denervation, Symplicity HTN-3, failed to show superiority of renal denervation by radiofrequency energy ablation compared with a sham procedure similar to the procedure used for denervation but without the application of energy to the renal artery.