Hypertension is both a cause and a consequence of chronic kidney disease (CKD), creating a bidirectional relationship that exacerbates cardiovascular and renal complications. The pathophysiology of hypertension in CKD is multifaceted, involving deregulation of the renin-angiotensin-aldosterone system (RAAS), endothelial dysfunction, volume overload, and increased arterial stiffness. Additionally, uremic toxins and oxidative stress further amplify vascular injury and inflammation, contributing to the progression of both hypertension and renal impairment. Traditional antihypertensive therapies, including RAAS inhibitors, calcium channel blockers, and diuretics, remain central to management; however, therapeutic challenges persist due to CKD-associated pharmacokinetic alterations and patient heterogeneity. Recent advancements in treatment approaches have introduced novel pharmacological and non-pharmacological interventions. These include using sodium-glucose cotransporter-2 (SGLT2) inhibitors, which have demonstrated Renoprotective and blood-pressure-lowering effects, and non-steroidal mineralocorticoid receptor antagonists, offering improved safety profiles. Emerging technologies such as renal denervation and baroreceptor activation therapy provide innovative, non-invasive options for resistant hypertension. Additionally, personalized medicine approaches, including genomics and biomarker-based risk stratification, hold promise for tailoring interventions to individual patient profiles. This review highlights the intricate interplay between hypertension and CKD pathophysiology, discusses recent advancements in therapeutic strategies, and underscores the need for a multidisciplinary approach to optimize patient outcomes. By integrating cutting-edge research with clinical practice, future strategy can mitigate the dual burden of hypertension and CKD, reducing morbidity and mortality in affected populations.
