CLINICAL PHARMACOLOGY AND THERAPEUTIC OPTIMIZATION OF ANTIHYPERTENSIVE DRUGS IN CHRONIC KIDNEY DISEASE

One of the main modifiable risk factors for the development and advancement of chronic kidney disease (CKD) and associated cardiovascular consequences is hypertension. Controlling blood pressure, protecting the kidneys, and maintaining metabolic stability are all necessary for managing hypertension in CKD. While mineralocorticoid receptor antagonists, calcium channel blockers, beta-blockers, and sodium-glucose cotransporter-2 (SGLT2) inhibitors play important supportive roles, angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) continue to be first-line agents due to their renoprotective and antiproteinuric effects. Current developments place a strong emphasis on tailored treatment based on pharmacogenomic variations, comorbidities, and CKD stage. Improved renoprotection and improved safety profiles are provided by novel medicines such endothelin receptor antagonists and nonsteroidal MRAs. However, there are still difficulties in reducing nephrotoxicity, hypotension, and hyperkalemia, which emphasizes the necessity of close observation. Future directions include using pharmacogenomics and precision medicine to tailor antihypertensive treatment and improve cardiovascular and renal outcomes in CKD, as well as incorporating artificial intelligence and digital health tools for ongoing blood pressure monitoring and therapeutic decision support.