Kidney Week 2025 Annual Meeting-Approach to Hypertension Treatment: Special Groups, Including the Sharon Silbiger, MD, Endowed Lectureship

Video Transcription

Video Summary

The session “Approach to Hypertension Treatment in Special Groups” covered hypertension management in dialysis, frail older adults, pregnancy, and post–kidney transplant patients.<br /><br />In hemodialysis, Prof. Harbir Kohli emphasized that “apparent” resistant hypertension is often driven by inadequate volume control rather than true drug resistance. Dry-weight reduction alone can meaningfully lower BP, but assessing volume is challenging; clinical assessment may be supplemented variably by bioimpedance, IVC diameter, or lung ultrasound, though long-term outcome benefits are uncertain. Home or ambulatory BP (not pre/post-dialysis readings) best predicts outcomes. Sodium intake and dialysate sodium prescriptions are underappreciated drivers of interdialytic weight gain and BP. Longer or more frequent dialysis and attention to dialyzable antihypertensives (e.g., many ACE inhibitors, atenolol) can improve control. Overly low BP targets may be harmful in dialysis populations.<br /><br />Dr. Andrew Nixon discussed frailty as a distinct, measurable syndrome affecting risk–benefit decisions in older adults. Guidelines vary, and evidence from trials like SPRINT may not generalize to severely frail or nursing-home populations. Observational data and deprescribing trials suggest overly aggressive BP lowering with multiple medications can increase harm in very frail elders. He recommended frailty screening (e.g., Clinical Frailty Scale), monitoring orthostatic hypotension, and using goal-directed, shared decision-making—especially in moderate/severe frailty.<br /><br />In the Sharon Silbiger Lectureship, Dr. Vesna Garovic reviewed hypertension in pregnancy. The CHAP trial supported treating chronic hypertension in pregnancy to <140/90, improving maternal–fetal outcomes without increasing growth restriction. Preeclampsia is linked to higher future cardiovascular and CKD risk, likely via heterogeneous mechanisms; better biomarkers, long-term follow-up strategies, and inclusion of pregnant patients in trials are needed.<br /><br />Finally, Dr. Daniel Brennan summarized post-transplant hypertension, noting multifactorial causes (including calcineurin inhibitors). Calcium channel blockers are often foundational; ACEi/ARBs are useful, while drug–drug interactions (e.g., diltiazem/verapamil raising tacrolimus) require vigilance.

Asset Subtitle

Moderator(s): Dina Abdellatif, Vivekanand Jha

Presentation(s):

Challenges in Hypertension Management in Patients Receiving Dialysis - Harbir Kohli
Approach to Hypertension Treatment in Older People Living with Frailty - Andrew Nixon
Hypertension and Pregnancy: The Sharon Silbiger, MD, Endowed Lectureship - Vesna Garovic
Post-Transplant Considerations in Hypertension Management - Daniel Brennan

ASN gratefully acknowledges Women in Nephrology (WIN) and its contributors for support of the Silbiger Endowed Lectureship.

ASN thanks the Indian Society of Nephrology (ISN) and ISN Ambassador, Dr. Harbir Kohli.

Meta Tag

Date 11/6/2025

Pathway 1 Hypertension and Cardiorenal Disorders

Pathway 2 CKD Non-Dialysis

Session ID 507314

Keywords

hypertension treatment

special populations

hemodialysis hypertension

volume control

dry weight reduction

home blood pressure monitoring

ambulatory blood pressure monitoring

dialysate sodium

interdialytic weight gain

dialyzable antihypertensives

frailty screening

Clinical Frailty Scale

hypertension in pregnancy

CHAP trial

post-kidney transplant hypertension