A European Renal Association (ERA) synopsis for nephrology practice of the 2023 European Society of Hypertension (ESH) Guidelines for the Management of Arterial Hypertension
ERA · 2024 · Europe
Source and licence
- Authors
- Pantelis Sarafidis, Roland Schmieder, Michel Burnier et al.
- Title
- A European Renal Association (ERA) synopsis for nephrology practice of the 2023 European Society of Hypertension (ESH) Guidelines for the Management of Arterial Hypertension
- Journal
- Nephrology Dialysis Transplantation, 2024
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC11139525
Licence statement of the original publication
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
CONCLUSIONS
- In all patients with CKD the primary goal is to lower office BP to <140/90 mmHg
In patients with CKD, a BP target of <120/70 mmHg is not recommended
- Step 1 of treatment includes combination of an ACEi or ARB + CCB or T/TLDiuretic if eGFR ≥30 mL/min/1.73 m2, or combination of an ACEi or ARB + CCB or loop diuretic if eGFR <30 mL/min/1.73 m2a
Step 3 of treatment includes addition of spironolactone if eGFR ≥30 mL/min/1.73 m2 and potassium within the normal range or chlortalidone if eGFR <30 mL/min/1.73 m2a
- SGLT2is are recommended for patients with diabetic and nondiabetic CKD, if eGFR is at least 20 mL/min/1.73 m2
The non-steroidal MRA finerenone is recommended in patients with CKD and albuminuria associated with T2DM, if eGFR is at least 25 mL/min/1.73 m2 and serum potassium <5.0 mmol/L
- In CKD patients with hyperkalemia a potassium binder can be used to maintain potassium <5.5 mmol/L to allow continuation of treatment with a RAS blocker or a MRA to continue
- Revascularization on top of medical therapy should be offered in patients with secondary hypertension due to ARVD or those with high-risk clinical phenotypes (flash pulmonary edema, refractory hypertension or rapid loss of kidney function) with documented high-grade stenosis≥70%
Abstract
In June 2023, the European Society of Hypertension (ESH) presented and published the new 2023 ESH Guidelines for the Management of Arterial Hypertension, a document that was endorsed by the European Renal Association (ERA). Following the evolution of evidence in recent years, several novel recommendations relevant to the management of hypertension in patients with chronic kidney disease (CKD) appeared in these Guidelines. These include recommendations for target office blood pressure (BP) <130/80 mmHg in most and against target office BP <120/70 mmHg in all patients with CKD; recommendations for use of spironolactone or chlorthalidone for patients with resistant hypertension with estimated glomerular filtration rate (eGFR) higher or lower than 30 mL/min/1.73 m2, respectively; use of a sodium-glucose cotransporter 2 inhibitor for patients with CKD and estimated eGFR ≥20 mL/min/1.73 m2; use of finerenone for patients with CKD, type 2 diabetes mellitus, albuminuria, eGFR ≥25 mL/min/1.73 m2 and serum potassium <5.0 mmol/L; and revascularization in patients with atherosclerotic renovascular disease and secondary hypertension or high-risk phenotypes if stenosis ≥70% is present. The present report is a synopsis of sections of the ESH Guidelines that are relevant to the daily clinical practice of nephrologists, prepared by experts from ESH and ERA. The sections summarized are those referring to the role of CKD in hypertension staging and cardiovascular risk stratification, the evaluation of hypertension-mediated kidney damage and the overall management of hypertension in patients with CKD.
Contents of the original publication
The section headings of the original.
- INTRODUCTION
- DEFINITION OF HYPERTENSION AND CLASSIFICATION OF BP
- RECOMMENDATIONS RELEVANT TO THE DIAGNOSIS OF HYPERTENSION-MEDIATED KIDNEY DAMAGE AND OTHER DIAGNOSTIC CONSIDERATIONS
- THE POSITION OF CKD IN ASSESSING THE OVERALL CARDIOVASCULAR RISK IN PATIENTS WITH HYPERTENSION
- TREATMENT OF HYPERTENSION IN CKD
- Initiation of treatment
- Treatment targets
- Lifestyle interventions
- Antihypertensive agents
- USE OF ADDITIONAL DRUGS THAT OFFER NEPHROPROTECTION AND CARDIOPROTECTION IN CKD
- HYPERTENSION IN KIDNEY TRANSPLANT RECIPIENTS
- RENOVASCULAR DISEASE
- CONCLUSIONS
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