**1. Introduction**

It is worldwide recognized the impact of kidney disease in economy and society. In developed countries, the costs associated with dialysis treatment and transplantation consume 2 to 3% of the health budget. On the other hand, in middle and low-income countries the accessibility to kidney function replacement treatments is low [1].

Chronic kidney disease (CKD) is considered a public health problem and has a significant weight in the context of chronic diseases. This disease affects around 850 million people worldwide, with one in ten adults having chronic kidney disease [2].

All stages of the disease - 1 to 5 -, are associated with increased risk of cardiovascular morbidity, premature mortality and quality of life decrease [3].

Considering the weight of hypertension, cardiovascular disease and diabetes mellitus in the increase of CKD, it is crucial to be concerned with its management.

## **2. Chronic kidney disease and hypertension**

There is a complex association between CKD and hypertension due to a causeeffect relationship, in which both hypertension and CKD have a risk factor sharing relationship, being that one may be the cause or consequence of the other. Every year the number of people diagnosed with CKD due to hypertension increases by 10%.

The literature states that 5% of CKD are due to hypertension. It is highlighted that hypertension is more common in glomerular diseases, but the incidence of this clinical condition differs according to the histological characteristics of the disease. Membranoproliferative glomerulonephritis and segmental and focal glomerulosclerosis forms have a higher incidence of hypertension than membranous forms and IgA glomerulopathy. **Table 1** shows the prevalence of hypertension in different chronic renal diseases [4].

The evidence supports that the prevalence of hypertension increases as kidney function deteriorates in CRD, with a progressive decrease in the glomerular filtration rate [5].

Several studies have shown that hypertension is an independent risk factor for end-stage renal disease (ESRD), contributing to the disease itself and its progression [6, 7].

Cardiovascular disease is the leading cause of death in CKD, which in turn, increases the risk of long-term cardiovascular events [8].

When compared to the general population, the prevalence of hypertension is higher in people with CKD, constituting the factor with the greatest impact on the progression and outcome of kidney disease [9].

It is not yet known the exact mechanism that causes hypertension in CKD, nor has been isolated any factor responsible for its establishment. It is theorized that there are several mechanisms that, acting together, contribute to increased blood pressure, such as the progressive loss of sodium excretion with the consequent volume overload, the excessive activity of the renin-angiotensin system, the disproportionate increase in sympathetic activity, secondary hyperparathyroidism, the reduction of nitric oxide synthesis and the high endothelin levels, among others [10, 11].


#### **Table 1.**

*Hypertension prevalence in CKD patients.*

#### *Self-Management of Blood Pressure Control at Home in Chronic Kidney Disease… DOI: http://dx.doi.org/10.5772/intechopen.96416*

Observational studies report an increased risk of development and rapid progression of CKD in cases of uncontrolled blood pressure [12].

Failure to treat hypertension is associated with harmful effects such as left ventricular hypertrophy, dilated cardiomyopathy and accelerated deterioration of renal function, among other causes [10].

According to Kidney Disease Improving Global Outcomes (KDIGO), international organizations (such as National Kidney Foundation Kidney Disease Outcomes Quality Initiative - NKF KDODQI; Eighth Joint National Committee published - JNC 8) committed to the prevention and treatment of hypertension recommend non-pharmacological measures along with pharmacological measures in the prevention and treatment of this disease [13, 14].

According to these organizations, health professionals are responsible for early detection of the disease and monitoring of risk factors.

The disease can progress slowly due to the gradual loss of the nephrons, and in its initial stages it goes unnoticed, only being identified when symptoms appear.

The purpose of screening and monitoring the disease in the early stages is to delay its progression to ESRD, a condition that leads to the need for renal replacement therapy.

Only a minority of patients with hypertension have blood pressure within the accepted target values (systolic blood pressure less than 140 mmHg, diastolic blood pressure less than 90 mmHg). The main causes for the lack of blood pressure control are related to low knowledge of the problem and lack of screening for hypertension in the population [15].

In the context of non-pharmacological measures, European Society of Cardiology makes clear the urgent need to promote preventive actions, mentioning that blood pressure measurement is a simple, non-invasive and low-cost technique, especially if considering the costs of treating hypertension and associated complications.

Regarding hypertension and kidney disease, there is no consensus among the authors about what the reference values should be. This is an issue that remains in debate despite recent recommendations and the publication of the clinical trials SPRINT, ACCORD, among others [16, 17].

The European Society of Hypertension and the European Society of Cardiology (ESH/ESC) recommend target blood pressure values below 140/90 mmHg for blood pressure measurements in a clinical setting. However, in the presence of proteinuria, these values drop to 130/80 mmHg as a reference. Similar recommendations are indicated by the JNC-8, suggesting target blood pressure values below 140/90 mmHg for the general population, disregarding the recommendations of SPRINT study, which suggests blood pressure values below 130/80 mmHg for patients at increased risk of cardiovascular events, including patients with CKD [18].

Target blood pressure values have changed over time. The literature shows that the target blood pressure value acceptable for patients with CKD is 130/80 mmHg [19]. The latest guidelines of the European Society of Hypertension and the European Society of Cardiology published in 2018 recommend a target SBP (Systolic Blood Pressure) value of 130–139 mmHg and DBP (Diastolic Blood Pressure) of 70–79 mmHg for patients with CKD. But there is not a unanimous view among scientific community on this issue [20, 21].

Vital for the success of the blood pressure prevention and control programs is the participation of the patient/family.

Health care, as integrating element of praxis, which takes place during the course of the chronic disease, calls for the participation of all stakeholders in

the care process and for the investment in patients' education, enabling them to understand their health needs and become co-responsible for their health and well-being [22].

Everybody should to be part of an active citizenship stance based on education and training. Care must focus on the needs of the patient, it is important to know their level of mastery in response to the needs considered significant at any stage of the disease pathway [23].
