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February 1, 1997Hypertension

Achievement and Safety of a Low Blood Pressure Goal in Chronic Renal Disease

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Why the study?

Does a low blood pressure goal (MAP <= 92 mm Hg) safely achieve lower blood pressure compared to a usual goal (MAP <= 107 mm Hg) in patients with chronic renal disease?

Population

585 patients with chronic renal disease and baseline glomerular filtration rate between 13 and 55 mL/min per…

Comparison

Low blood pressure goal using antihypertensive… vs Usual blood pressure goal.

Design

RCT, randomly assigned

Key result

A low blood pressure goal was achievable in patients with chronic renal disease (achieved MAP 93.0 vs 97.7 mm Hg for usual goal) without serious adverse effects.

Authors

JLJ. Michael LazarusJBJacques J. BourgoignieVBVardaman M. Buckalew

Discussion

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Overview

Supports lower MAP targets in CKD without serious harm; extends renal protection evidence to proteinuric patients.

Study Design

Type

RCT (n=585)

Structured PICO

Does a low blood pressure goal (MAP <= 92 mm Hg) safely achieve lower blood pressure compared to a usual goal (MAP <= 107 mm Hg) in patients with chronic renal disease?

P
Population
585 patients with chronic renal disease and baseline glomerular filtration rate between 13 and 55 mL/min per 1.73 m2, with few having a history of cardiovascular disease.
I
Intervention
Low blood pressure goal (mean arterial pressure <= 92 mm Hg) using antihypertensive agents (angiotensin-converting enzyme inhibitors preferred, followed by calcium channel blockers).
C
Comparator
Usual blood pressure goal (mean arterial pressure <= 107 mm Hg).
O
Outcome
Achieved blood pressure, baseline characteristics affecting achievement, and safety of the blood pressure interventions (stop points, hospitalizations, or death).safety

Main Result

Absolute Event Rate: 93% vs 97.7%

A lower blood pressure goal (MAP <= 92 mm Hg) is achievable and safe in patients with chronic renal disease without cardiovascular disease, though it requires more medication changes and causes more symptoms of low blood pressure.

Cite This Study

Lazarus et al. (1997) conducted an RCT in Chronic Renal Disease (n=585). Low blood pressure goal (mean arterial pressure ≤ 92 mm Hg) vs. Usual blood pressure goal (mean arterial pressure ≤ 107 mm Hg) was evaluated on Achieved mean arterial pressure. A low blood pressure goal was achievable in patients with chronic renal disease (achieved MAP 93.0 vs 97.7 mm Hg for usual goal) without serious adverse effects.

synapsesocial.com/papers/6a174c5c3d715b2f195e019dhttps://doi.org/10.1161/01.hyp.29.2.641
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