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Sheffield Kidney Institute
Hypertension and CKD
2nd Qatar Nephrology Meeting 2016
Prof Meguid El Nahas, MD, PhD, FRCP
Professor of Nephrology & Chairman
Global Kidney Academy
Sheffield, UK
Sheffield Kidney Institute
Global Scale
of
Hypertension
Sheffield Kidney Institute
Ibrahim & Dasmasceno, 2012
Sheffield Kidney Institute Kearney et al, 2005
972m
1.56b
Global Hypertension
2000
2025
India/LA
60m
China
90 Africa
40
100m
150
70
Sheffield Kidney Institute
Ibrahim & Dasmasceno, 2012
Sheffield Kidney Institute
Ibrahim & Dasmasceno, 2012
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Hypertension
&
CKD
Sheffield Kidney Institute
Sheffield Kidney Institute
MRFIT Study, Klag et al, 1996
Sheffield Kidney Institute
Sheffield Kidney Institute
El Nahas, KI 2010
Sheffield Kidney Institute
CVD & C-K-D
Macrovascular disease
Sheffield Kidney Institute
How to
Measure BP
in CKD?
Sheffield Kidney Institute
What is the most Predictive value for CVD:
a. Systolic Office BP
b. Diastolic Office BP
c. Night Time BP
d. 24h ABPM
Sheffield Kidney Institute
What is the
BP Target
in CKD?
Sheffield Kidney Institute
Observational Studies
Sheffield Kidney Institute
Sheffield Kidney Institute
CKD progression and BP control
MDRD Study – BP and long term outcomes
Sarnak M et al , 2005
Sheffield Kidney Institute
CKD Progression and BP Meta-Analysis
Jafar et al, 2003
Sheffield Kidney Institute
Clinical Trials
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
HOPE Study
Svensson et al, 2001
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
BP Target
BP < 140/90mmHg
BP <130/80mmHg
Sheffield Kidney Institute
Levey et al. KI, 2011
KDIGO 2012
<140/90
<130/80
<120/70
Sheffield Kidney Institute
What
Drug in
CKD?
Sheffield Kidney Institute
Sheffield Kidney Institute
Loss AutoRegulation
Afferent arteriolar
Vasodilatation
AII
Glomerular Hyperfiltration
Sheffield Kidney Institute
Loss AutoRegulation
Afferent arteriolar
Vasodilatation
X
RAS
Glomerular Hyperfiltration
Sheffield Kidney Institute
Sheffield Kidney Institute
Giatras et al, 1997
Sheffield Kidney Institute
Casas et al, 2005
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
ONTARGET
Mann et al, 2008
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
Susantitahong et al, 2013
Sheffield Kidney Institute
Susantitahong et al, 2013
Sheffield Kidney Institute
Susantitahong et al, 2013
Sheffield Kidney Institute
Sheffield Kidney Institute
Ahmed et al, 2011
Older CKD
STOP ACE
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
El Nahas, KI 2010
Sheffield Kidney Institute
Ageing Ischemic Nephropathy
Macrovascular disease
Sheffield Kidney Institute
Angiotensin II
Atherosclerosis
Sheffield Kidney Institute
X
RASi
Atherosclerosis
Sheffield Kidney Institute
X
Dual RASi
Atherosclerosis
X
X
Sheffield Kidney Institute
What is the
BP Target in
CKD5?
Sheffield Kidney Institute
Ahmed, A. K. et al. 2009
Changes in eGFR after stopping ACEi/ARB in patients
with advanced CKD
Sheffield Kidney Institute
Goncalves et al, 2012
Sheffield Kidney Institute
Sheffield Kidney Institute
Tailor:
Age
Race
Co-Morbidity
Stage
BP
CKD
Sheffield Kidney Institute
Sheffield Kidney Institute
Sheffield Kidney Institute
<140/90
<130/80
<120/70
Age
Co-Morbidities
Stage
Race
Proteinuria
Sheffield Kidney Institute
Hypertension and CKD
2nd Qatar Nephrology Meeting 2016
Prof Meguid El Nahas, MD, PhD, FRCP
Professor of Nephrology & Chairman
Global Kidney Academy
Sheffield, UK

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