Drexler, Y.R. & Bomback, A.S. (2013). Definition, identification and treatment of resistant hypertension in chronic kidney disease patients. Nephrology Dialysis Transplantation, 0, 1-9.
Drexler and Bomback aims at discussing the conditions of patients with chronic kidney disease (CKD) and the impact of resistant hypertension in order to offer an appropriate algorithm for treatment. They give clear explanations of what resistant hypertension is, how it may affect the development of the CKD, and what CKD patients expect from treatment. Resistant hypertension prevalence is an unknown issue “due to the feasibility of conducting a large, forced titration study to answer this question” (Drexler & Bomback, 2013, p. 1). The point is that blood pressure measurements have a number of shortcomings, this is why it is very important to pay enough attention to ambulatory blood pressure monitoring over 24 hours. The authors define 24-h ABPM as the best method of treatment for patients with CDK. Their findings show that ABPM helps to “capture nighttime blood pressures and to identify the presence of a non-dipping pattern” (Drexler & Bomback, 2013, p. 3).
As the majority of medical investigations, the article under consideration has its own shortcomings that may influence the development of the research and the conclusions offered. For example, the authors mention that obesity may influence treatment; still, they fail to pay enough attention to this condition. It seems to be possible to avoid mentioning this particular topic or, at least, talk more about it.
In general, the authors’ conclusions clearly define their position that 24-h ABPM is helpful for treating patients with hypertension and chronic kidney disease. The offered physiology-based algorithm improves blood pressure control and requires more attention to be paid in further investigations in the chosen field.
Tedla, F.M., Brar, A., Browne, R., & Brown, C. (2011). Hypertension in chronic kidney disease: Navigating the evidence. International Journal of Hypertension, 2011, 1-9.
In this article, the authors define hypertension as a cause and consequence of CKD. A number of clinical trials have been used to prove that blood pressure control has a connection to the progression of the disease; still, some clear and definite conclusions have not been made. This is why the main goal of the article is to focus on the ways of treatment of hypertension in different forms of CKD and identify some gaps in the already offered material. The chosen article is properly structured: the authors identify such sections like epidemiology (introduce a general picture of CKD in the USA), pathophysiology (explain the connection between hypertension and chronic kidney disease), therapy (underline the importance of blood pressure control and describe different types of therapies available for patients), and gaps (talk about possible improvements in the chosen sphere of medicine) (Tedla, Brar, Browne, & Brown, 2011).
The findings of the research prove that it is necessary to consider the nature of kidney disease, its origins, and development stages. It is also necessary to admit that patients with diabetes require more attention because their treatment is unique.
The main shortcoming of the work is the authors’ inability to use the results of their own investigation but rely and analyze the already known facts and material. Of course, it is one of the possible forms of researching, but, it is not always the most effective one. The authors conclude that combination therapy is one of the possible ways to help patients with high blood pressure and chronic kidney disease. This is why it is interesting to continue the investigations of the chosen article and define other interesting approaches of treatment.
Turner, J.M., Bauer, C., Abramowitz, M.K., Melamed, M.L., & Hostetter, T.H. (2012). Treatment of chronic kidney disease. Kidney International, 81, 351-362.
The authors underline that treatment of chronic kidney disease is an important step that has to be done in order to slow any kind of possible progression of end-stage renal disease (ESRD) (Turner, Bauer, Abramowitz, Melamed, & Hostetter, 2012). The main causes of ESRD are hypertension and diabetes may be prevented by means of special diets, blood pressure control, weight control, etc. People should learn how CKD treatment should be organized and why it cannot be neglected.
Specialists cannot give appropriate recommendations for the measures of blood pressure for patients with CKD. The authors aim at understanding of the reasons of why people may have high blood pressure and motivating patients with the required portion of help. Turner et al. (2012) admit that “lowering uric acid with allopurinol reduced blood pressure” (p. 355). Though the findings are not conclusive, they help to understand that clinics have a number of tools and possibilities to help people with chronic kidney disease. Still, the majority of activities offered to patients are not always effective. There is a burning need of new reliable markers of renal disease. Such innovations may promote faster and, what is more important, less expensive treatment. The main shortcoming of the work is author’s attention to the necessity of patients’ education about their disease, but inability to provide interesting and effective methods of education. The reader knows that some steps have to be taken to learn more about CKD and its connection with hypertension, but he/she cannot understand how to apply theoretical knowledge to practice. However, the article contains interesting facts about the importance of Vitamin D and different hormones in the organism and promotes further investigations in the chosen field.
James, M.T., Hemmelgam, B.R., & Tonelli, M. (2010). Early recognition and prevention of chronic kidney disease. Lancet, 375, 1296-1309.
James, Hemmelgam, and Tonelli (2010) admit that chronic kidney disease is one of those disorders with prevalence that is increasing worldwide. It is necessary to pay enough attention to its early recognition and possible preventive measures. High blood pressure is defined as one of the possible symptoms of further complications for people with CKD, this is why it is necessary to provide patients with treatment of hypertension in time.
The chosen research helps to understand that there are many patients with CKD, who are in need of several antihypertensive drugs at the same time (James et al., 2010). However, it is not always possible to define what kinds of drugs are more appropriate without appropriate consideration of comorbidities. This fact turns out to be one of the shortcomings noticed in the article. The authors admit the necessity of paying attention to different comorbidities, still, they fail to explain how they can be identified and how the problem of the additional drug usage can be solved.
The authors conclude that some better clinical methods are required in order to analyze the outcomes of high blood pressure on patients with CKD. The evaluation of possible risks of treating patients with CKD proves that the combination of drugs is an effective method, still, it should be properly elaborated “in view of the high prevalence of polypharmacy and potential for toxic effects of drugs” (James et al., 2010, p. 1306). In general, the article introduces a powerful idea of how important early recognition of chronic kidney disease can be. The writers insist on defining high blood pressure as a crucial symptom that cannot be neglected on its early stages, and the experts should develop new techniques to achieve better results in medicine.
Reference List
Drexler, Y.R. & Bomback, A.S. (2013). Definition, identification and treatment of resistant hypertension in chronic kidney disease patients. Nephrology Dialysis Transplantation, 0, 1-9.
James, M.T., Hemmelgam, B.R., & Tonelli, M. (2010). Early recognition and prevention of chronic kidney disease. Lancet, 375, 1296-1309.
Tedla, F.M., Brar, A., Browne, R., & Brown, C. (2011). Hypertension in chronic kidney disease: Navigating the evidence. International Journal of Hypertension, 2011, 1-9.
Turner, J.M., Bauer, C., Abramowitz, M.K., Melamed, M.L., & Hostetter, T.H. (2012). Treatment of chronic kidney disease. Kidney International, 81, 351-362.