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January 10, 2026Current Opinion in Nephrology & Hypertension

Pros and cons of lower blood pressure targets in chronic kidney disease

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Key result

Targeting SBP <120 mmHg reduces CV events and mortality in nondialysis CKD but increases AKI risk.

Why the study?

Recent updates in major international guidelines present differing recommendations for blood pressure targets in CKD, contributing to clinical uncertainty regarding the benefits and risks of lower targets.

Do lower systolic blood pressure targets (<120 mmHg) reduce cardiovascular events and mortality in patients with nondialysis chronic kidney disease?

Population

Patients with CKD

Comparison

Lower blood pressure targets vs standard targets

Design

Review

Authors

MHMario Funes HernandezTCTara I. Chang

Discussion

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Overview

Supports individualized lower SBP targets in nondialysis CKD despite AKI risk; leaves open optimal thresholds for dedicated RCTs.

Key Points

  • This review explores the benefits and risks of targeting lower blood pressure in chronic kidney disease patients.
  • Summarized findings from recent randomized trials and meta-analyses
  • Assessed cardiovascular events and all-cause mortality rates
  • Evaluated impact of standardized blood pressure measurements
  • Identified potential risks of acute kidney injury and CKD progression
  • Lower systolic blood pressure (<120 mmHg) may reduce cardiovascular events and mortality in non-dialysis CKD.
  • Benefits were consistent with findings in the general population.
  • Lower targets could increase risks of incident CKD and acute kidney injury.
  • Significant benefits for slowing CKD progression noted mostly in patients with high proteinuria.

Structured PICO

Do lower systolic blood pressure targets (<120 mmHg) reduce cardiovascular events and mortality in patients with nondialysis chronic kidney disease?

P
Population
Patients with nondialysis chronic kidney disease
I
Intervention
Lower systolic blood pressure targets (<120 mmHg) using standardized blood pressure measurements
O
Outcome
Cardiovascular events and all-cause mortalityhard clinical

Lower blood pressure targets (<120 mmHg) in nondialysis CKD provide cardiovascular benefits but require individualized approaches due to increased risks of AKI.

Limitations

  • Patients with advanced CKD and heavier proteinuria remain underrepresented in the trials
  • Frail or other high-risk subgroups were often excluded from trials

Cite This Study

Hernandez et al. (2025) studied this question. Targeting lower systolic blood pressure (<120 mmHg) reduces cardiovascular events and all-cause mortality in nondialysis CKD but can increase AKI risk.

synapsesocial.com/papers/6963221491e05aa366cb88behttps://doi.org/10.1097/mnh.0000000000001153
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Blood pressure targets in chronic kidney disease: still no consensus2023 · 7 citations
  2. 2Systematic Review: Blood Pressure Target in Chronic Kidney Disease and Proteinuria as an Effect Modifier2011 · 343 citations
  3. 3Blood pressure targets for hypertension in people with chronic renal disease2024 · 6 citations
  4. 4Blood pressure targets for hypertension in people with chronic renal disease2019 · 2 citations
  5. 5Optimal targets for blood pressure control in chronic kidney disease2014 · 6 citations