Treatment of Hypertension in CKD patients Illustrative case A 56-year M CKD patient was admitted with breathlessness due for hemodialysis. He was a known DM, HTN on Tab Amlodipine 10 mg PO BD. Blood pressure was unusually high since morning on the day of admission. Choice and timing of an add on antihypertensive was to be decided. == Hypertension is both the cause and effect of CKD. Controlling hypertension reduces cardiovascular morbidity and progression of CKD. Decline in GFR increases sympathetic tone and activates the Renin Angiotensin Aldosterone (RAAS) System. Proteinuria is both a marker of CKD and can be used for the progression of CKD over time Albumin to creatinine ratio > 3 mg/ mmol in spot urine is easier to test and more reliable over 24-hour proteinuria. The presence of proteinuria effects the choice of antihypertensive medicines. Albumin > 300 mg per 24-hour urine collection is the standard Albumin > 1 gm per 24-hour ur