What is the initial therapy for patients with hypertension and chronic kidney disease (CKD)?

The initial therapy for patients with hypertension and chronic kidney disease (CKD) should focus on renal protection and managing blood pressure effectively. ACE inhibitors or Angiotensin II Receptor Blockers (ARBs) are specifically beneficial because they provide renal protection by reducing intraglomerular pressure and preventing the progression of kidney disease. They also have a favorable effect on blood pressure control.

In CKD, there is a higher risk of cardiovascular events and complications, and ACE inhibitors or ARBs help mitigate this risk. These medications also have additional advantages, such as improving proteinuria levels, which can be a concern in CKD patients. By blocking the renin-angiotensin system, they can help in maintaining renal function while also effectively controlling hypertension.

Other classes of antihypertensive agents, while they may be used in various conditions, do not provide the same dual benefit of controlling blood pressure while protecting the kidneys. For instance, thiazides can be effective for hypertension but are not recommended as first-line therapy for CKD when there is any degree of renal impairment. Beta-blockers are also not specifically indicated as initial therapy for hypertension in CKD patients and do not offer the same protective effect on the kidneys. Calcium channel blockers can lower blood pressure