{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T05:17:47Z","timestamp":1789103867756,"version":"build-2803163510"},"reference-count":122,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T00:00:00Z","timestamp":1761696000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Hypertension in chronic kidney disease (CKD) is a major health challenge, with cardiovascular disease being the major cause of mortality in CKD. Several factors play a role in its pathophysiology, including renin-angiotensin system activation. Guidelines for blood pressure management in CKD patients demonstrate some variation in their recommended targets and therapeutic approach. However, current practice increasingly adopts stricter systolic blood pressure target when tolerable. A daily sodium intake of less than 2 grams and engagement in moderate-intensity physical activity (\u226530 min, 5\u20137 days per week) are strongly recommended. However, the majority of patients with CKD ultimately require combination therapy with multiple antihypertensive agents, such as calcium channel blockers (CCBs) and thiazide or thiazide-like diuretics. Recent evidence is increasingly in favor of considering sodium-glucose cotransporter-2 (SGLT-2) inhibitors, incretin therapies, and mineralocorticoid receptor antagonists (MRAs), given their established benefits on cardiovascular and kidney-related outcomes, even though their blood pressure lowering effects remains relatively modest. Emerging agents with novel mechanisms of action, such as endothelin receptor antagonists, are also under investigation and may provide additional therapeutic options in the future. This review aims to summarize current guideline recommendations and therapeutic strategies for managing hypertension in CKD, including recent and emerging pharmacologic approaches.<\/jats:p>","DOI":"10.3389\/fmed.2025.1630160","type":"journal-article","created":{"date-parts":[[2025,10,29]],"date-time":"2025-10-29T06:46:32Z","timestamp":1761720392000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["Management of hypertension in chronic kidney disease: current perspectives and therapeutic strategies"],"prefix":"10.3389","volume":"12","author":[{"given":"Muath A.","family":"Alsalloum","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed A.","family":"Albekery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim S.","family":"Alhomoud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,29]]},"reference":[{"key":"ref1","volume-title":"USRDS annual data report: Epidemiology of kidney disease in the United States","year":"2024"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e24244","DOI":"10.7759\/cureus.24244","article-title":"Blood pressure and chronic kidney disease progression: an updated review","volume":"14","author":"Habas","year":"2022","journal-title":"Cureus"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"352","DOI":"10.34067\/KID.0000000000000374","article-title":"Mortality, health care burden, and treatment of CKD: a multinational, observational study (OPTIMISE-CKD)","volume":"5","author":"Tangri","year":"2024","journal-title":"Kidney360"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"55","DOI":"10.1007\/s11906-022-01173-w","article-title":"The burden of resistant hypertension across the world","volume":"24","author":"Brant","year":"2022","journal-title":"Curr Hypertens Rep"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1463","DOI":"10.1016\/j.ekir.2022.04.094","article-title":"Prescribing SGLT2 inhibitors in patients with CKD: expanding indications and practical considerations","volume":"7","author":"Yau","year":"2022","journal-title":"Kidney Int Rep"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1053\/j.ajkd.2020.04.017","article-title":"Resistant hypertension in people with CKD: a review","volume":"77","author":"Fay","year":"2021","journal-title":"Am J Kidney Dis"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"e235","DOI":"10.37765\/ajmc.2023.89410","article-title":"Dialysis costs for a health system participating in value-based care","volume":"29","author":"Wong","year":"2023","journal-title":"Am J Manag Care"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1038\/kisup.2013.69","article-title":"Early diagnosis saves lives: focus on patients with hypertension","volume":"3","author":"Gulec","year":"2013","journal-title":"Kidney Int Suppl"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"514","DOI":"10.1161\/01.HYP.0000178102.85718.66","article-title":"Correlates of systolic hypertension in patients with chronic kidney disease","volume":"46","author":"Agarwal","year":"2005","journal-title":"Hypertension"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"57","DOI":"10.5049\/EBP.2022.20.2.57","article-title":"Blood pressure control in elderly chronic kidney disease patients","volume":"20","author":"Yang","year":"2022","journal-title":"Electrolyte Blood Press"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1161\/01.hyp.37.3.869","article-title":"Predominance of isolated systolic hypertension among middle-aged and elderly US hypertensives: analysis based on National Health and nutrition examination survey (NHANES) III","volume":"37","author":"Franklin","year":"2001","journal-title":"Hypertension"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"2160","DOI":"10.1111\/jgs.12551","article-title":"Awareness, and treatment rates in chronic kidney disease patients with hypertension in China collaborative group. 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