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September 5, 2014Current Opinion in Nephrology & Hypertension

Optimal targets for blood pressure control in chronic kidney disease

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Key result

Blood pressure targets of <140/90 mmHg (or <130/80 mmHg for proteinuric disease) are recommended for chronic kidney disease, though evidence strength diminishes in advanced disease.

Why the study?

What are the optimal blood pressure control targets for patients with chronic kidney disease?

Population

Patients with chronic kidney disease (CKD), including advanced CKD and proteinuric renal disease

Design

Review

Authors

JKJohn KnightMWMuh Geot WongVPVlado Perkovic

Discussion

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Overview

BP targets in advanced CKD remain debated; leaves open optimal thresholds pending dedicated RCTs.

Structured PICO

What are the optimal blood pressure control targets for patients with chronic kidney disease?

P
Population
Patients with chronic kidney disease (CKD), including advanced CKD and proteinuric renal disease
I
Intervention
Blood pressure control targets (<140/90 generally, <130/80 for proteinuric disease) and antihypertensive therapy (ACEi or ARB)

Current guidelines recommend specific BP targets for CKD, but highlight a critical gap in evidence for patients with advanced CKD, necessitating future dedicated clinical trials.

Limitations

  • Advanced CKD is often an exclusion criterion for large randomized trials
  • New data from trials are scant
  • Evidence strength and generalizability diminish as the kidneys fail
  • Evidence strength and generalizability diminish as kidneys fail

Cite This Study

Knight et al. (2014) conducted a review in Chronic kidney disease and hypertension. Blood pressure targets was evaluated. Blood pressure targets of <140/90 mmHg (or <130/80 mmHg for proteinuric disease) are recommended for chronic kidney disease, though evidence strength diminishes in advanced disease.

synapsesocial.com/papers/6a6c9a26f44fa9f079db4f2fhttps://doi.org/10.1097/mnh.0000000000000060
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Also Consider

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

  1. 1Commentary on the KDIGO Clinical Practice Guideline for the management of blood pressure in chronic kidney disease2013 · 30 citations
  2. 22014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults2013 · 8,071 citations
  3. 3Effects of Blood Pressure Control on Progressive Renal Disease in Blacks and Whites1997 · 154 citations
  4. 4Impact of Achieved Blood Pressure on Cardiovascular Outcomes in the Irbesartan Diabetic Nephropathy Trial2005 · 328 citations
  5. 5Hypertension in hemodialysis patients treated with atenolol or lisinopril: a randomized controlled trial2014 · 229 citations