Which agent is preferred for hypertension management in ADPKD?

Which agent is preferred for hypertension management in ADPKD?

• A. Beta-blocker
• B. ACE inhibitors
• C. Calcium channel blocker
• D. Thiazide diuretic

Answer: (B)

Hypertension in ADPKD is largely driven by increased renin-angiotensin-aldosterone system activity from cyst-related reduced renal perfusion, which both raises blood pressure and accelerates kidney injury. Blocking this system with an ACE inhibitor lowers angiotensin II, causing efferent arteriolar dilation, reducing intraglomerular pressure, and decreasing proteinuria. This combination not only helps control blood pressure but also provides renoprotective effects that slow progression of kidney disease in ADPKD, making ACE inhibitors the preferred first-line choice. Other antihypertensives can lower BP, but they don’t offer the same targeted renal protection in this condition, so they are generally used as adjuncts or alternatives if ACE inhibitors aren’t tolerated. If needed, ARBs are a reasonable alternative when ACE inhibitors are not suitable.

Hypertension in ADPKD is largely driven by increased renin-angiotensin-aldosterone system activity from cyst-related reduced renal perfusion, which both raises blood pressure and accelerates kidney injury. Blocking this system with an ACE inhibitor lowers angiotensin II, causing efferent arteriolar dilation, reducing intraglomerular pressure, and decreasing proteinuria. This combination not only helps control blood pressure but also provides renoprotective effects that slow progression of kidney disease in ADPKD, making ACE inhibitors the preferred first-line choice. Other antihypertensives can lower BP, but they don’t offer the same targeted renal protection in this condition, so they are generally used as adjuncts or alternatives if ACE inhibitors aren’t tolerated. If needed, ARBs are a reasonable alternative when ACE inhibitors are not suitable.