The first therapeutic goal is to achieve normotensive blood pressure values. It is important to achieve this goal continuously, as there are indications that even short-term increases in pressure lead to a significant and also permanent deterioration in kidney function. It is likely that a reduction in pressure to values < 140 / 90 mmHg is sufficient (Wolff 2012).
If the patient has proteinuria, angiotensin inhibitors should be used (Wolff 2012).
If diabetes mellitus or renal disease is already present, the guidelines recommend a blood pressure setting of < 130 / 80 mmHg (Kasper 2015). To date, no benefit has been demonstrated from lowering < 130 mmHg systolic, even with an eGFR < 20 ml / min / 1.73m2 (Bock 2019).
In the presence of renal disease, antihypertensive treatment is initially by 2 drugs:
plus
However, most patients require a 3rd medication. (Kasper 2015)