Question

A 70-year-old woman with chronic kidney disease (eGFR 38 mL/min/1.73 m²) and persistent albuminuria attends for blood pressure review. Her average clinic blood pressure is 146/88 mmHg despite maximised ACE inhibitor therapy. According to Australian CKD guidance, what is the most appropriate next step in pharmacological blood pressure management?

Accepted Answer

Add a thiazide or thiazide-like diuretic to the ACE inhibitor

Answer

Add a mineralocorticoid receptor antagonist such as spironolactone as second-line

Answer

Switch from an ACE inhibitor to an angiotensin receptor blocker

Answer

Cease ACE inhibitor and start a non-dihydropyridine calcium channel blocker

Answer

No change; her current blood pressure is acceptable for CKD

Practice question