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January 1, 2023˜The œNephron journals/Nephron journals

What Is Wrong with the Blood Pressure Target Recommendation of KDIGO 2021 for Hypertension in Chronic Kidney Disease?

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Key result

Targeting systolic blood pressure to less than 120 mm Hg in patients with chronic kidney disease is hard to substantiate and may lead to polypharmacy, added cost burden, and risk of serious harms.

Why the study?

Although optimizing blood pressure is widely accepted in chronic kidney disease, blood pressure targets in this population are not known, prompting a critical review of the KDIGO 2021 recommendation.

Does targeting systolic blood pressure to less than 120 mm Hg improve outcomes or cause harm in patients with chronic kidney disease compared to standard targets?

Population

Patients with CKD and hypertension

Comparison

Systolic BP target <120 mm Hg vs previous recommendations (<140 mm Hg or <130 mm Hg with proteinuria)

Design

Review

Authors

TJTukaram JamaleMKManjunath KulkarniVKVaibhav Keskar

Discussion

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Overview

Supports intensive BP control in CKD; extends evidence synthesis to guide practice and future trials.

Structured PICO

Does targeting systolic blood pressure to less than 120 mm Hg improve outcomes or cause harm in patients with chronic kidney disease compared to standard targets?

P
Population
Patients with chronic kidney disease (CKD) and hypertension
I
Intervention
Intensive blood pressure lowering (target systolic BP <120 mm Hg)
C
Comparator
Standard blood pressure lowering (target systolic BP <140 mm Hg for all CKD patients and <130 mm Hg for those with proteinuria)

The KDIGO 2021 recommendation for a systolic BP target of <120 mm Hg in CKD patients is challenged due to insufficient robust data and potential for harm.

Cite This Study

Jamale et al. (2023) conducted a review in Hypertension in Chronic Kidney Disease. Targeting systolic blood pressure to less than 120 mm Hg vs. <140 mm Hg or <130 mm Hg with proteinuria was evaluated. Targeting systolic blood pressure to less than 120 mm Hg in patients with chronic kidney disease is hard to substantiate and may lead to polypharmacy, added cost burden, and risk of serious harms.

synapsesocial.com/papers/6a5c19b1aec5d4d5ba1e89ffhttps://doi.org/10.1159/000531029
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Also Consider

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

  1. 1Effects of Intensive BP Control in CKD2017 · 476 citations
  2. 2Intensive Blood-Pressure Control in Hypertensive Chronic Kidney Disease2010 · 721 citations
  3. 3Association Between More Intensive vs Less Intensive Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease Stages 3 to 52017 · 210 citations
  4. 4Estimated glomerular filtration rate and the risk–benefit profile of intensive blood pressure control amongst nondiabetic patients: a post hoc analysis of a randomized clinical trial2017 · 64 citations
  5. 5Does a blood pressure J curve exist for patients with chronic kidney disease?2017 · 16 citations