https://www.vetsurgeon.org/f/clinical-questions/30541/too-cautious-with-anti-hypertensives-in-ckd-dog Good morning, My patient is a 13 year old MN cocker spaniel with IRIS stage III, hypertensive, proteinuric CKD. Diagnosed in September. He is on a renal diet (95% compliance), Vetpro renal phosphate binder TID, ALOH TID, Porous One, benazapril 0en-USTelligent Community 10https://www.vetsurgeon.org/thread/240735?ContentTypeID=1Fri, 03 Feb 2023 08:12:45 GMT146601cc-3922-4be7-9974-7e1d4e45a66b:22ed4567-7eb0-4a71-91f7-c40401e54aa5Andrew Kent<p>Hi Sara,</p> <p>Sorry for the slow reply.</p> <p>I think these cases are challenging and probably everybody would do something different.</p> <p>Are we convinced the BP readings are reliable? Any retinal changes to support persistent hypertension? (I always find myself questioning BP in our patients which is a major limitation for us in general).</p> <p>We are often pretty poor at managing proteinuria in dogs and the response to therapy is often disappointing. Remarkably some seem to tolerate this well but, as you say, some just continue to deteriorate.</p> <p>In general, personally, if I have a significantly hypertensive proteinuric I tend to reach to telmisartan first given it likely has a better anti-hypertensive impact than benazepril. So you could consider switching the ACEi for that and see if the response is similar. You can even combine if needed but your potassium would make me a bit nervous about doing that initially.</p> <p>Otherwise difficult to avoid the gradual up-titration of doses with appropriate blood/BP monitoring and, sadly, often we never get where we want to be.</p> <p>Frustrating cases for sure!</p> <p>Andy</p><div style="clear:both;"></div>