New insights in the pathophysiology and treatment of hypertension in autosomal dominant polycystic kidney disease.

Abstract

Hypertension is a frequent and early manifestation in autosomal dominant polycystic kidney disease, significantly associated with kidney function decline and cardiovascular outcomes. Autosomal dominant polycystic kidney disease-related hypertension arises from mechanisms unique to the disease, including renin-angiotensin-aldosterone system activation driven by cyst expansion and endothelial dysfunction. Recent studies highlight the importance of early diagnosis and optimal blood pressure management in autosomal dominant polycystic kidney disease. The 2025 Kidney Disease: Improving Global Outcomes guideline recommends a blood pressure target of ≤110/75 mm Hg in hypertensive patients aged 18-49 years with preserved kidney function, and <120 mm Hg systolic blood pressure in older adults when tolerated. Renin-angiotensin-aldosterone system inhibitors remain the first-line antihypertensive therapy, while emerging strategies hold promise for addressing specific mechanisms and refractory cases. Special populations, including children and pregnant women, present unique challenges and require tailored management strategies. This review synthesizes the latest insights into the pathophysiology and management of hypertension in autosomal dominant polycystic kidney disease, underscoring the need for personalized approaches and future research to refine therapeutic options.