How should I manage hypertension in a patient diagnosed with ADPKD?

In managing hypertension in a patient with autosomal dominant polycystic kidney disease (ADPKD), the primary goal is to control blood pressure to slow kidney disease progression and reduce cardiovascular risk. Blood pressure targets should generally be below 140/90 mmHg for adults under 80 years, and lower targets (below 130/80 mmHg) may be considered if there is significant albuminuria or more advanced chronic kidney disease ⁴.

Pharmacological treatment should start promptly, with an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) as first-line agents, given their renal protective effects and ability to reduce cyst growth and progression in ADPKD ¹[(Akoh, 2015)]. If ACE inhibitors are not tolerated, ARBs are preferred alternatives ¹. Combination of ACE inhibitors and ARBs is not recommended due to increased risk of adverse effects ¹.

Calcium-channel blockers and thiazide-like diuretics may be added if blood pressure remains uncontrolled, but ACE inhibitors or ARBs remain the cornerstone of therapy due to their specific benefits in ADPKD ¹[(Akoh, 2015)].

Lifestyle advice is essential and includes reducing dietary sodium intake, avoiding potassium-containing salt substitutes (especially important in kidney disease and when on ACE inhibitors or ARBs), encouraging weight loss if overweight, limiting alcohol intake, reducing caffeine, and smoking cessation ¹,²,³,⁴.

Regular monitoring of blood pressure using clinic or home measurements is recommended, with adjustments to therapy as needed to maintain target blood pressure ⁴. Additionally, monitoring kidney function and albuminuria is important to assess disease progression and treatment efficacy ⁴.

Over-the-counter medications such as NSAIDs should be avoided or used cautiously as they can worsen kidney function ²,³.

In summary, hypertension management in ADPKD involves early initiation of ACE inhibitors or ARBs, lifestyle modifications, careful monitoring, and avoidance of nephrotoxic agents to slow disease progression and reduce cardiovascular risk ¹[(Akoh, 2015)].