The 2018 ESC/ESH hypertension guidelines: Should nephrologists always stop at the lower boundary?

In patients with chronic kidney disease (CKD), hypertension is a major challenge because of its high prevalence, the consequent increase in cardiovascular morbidity and mortality, and the risk it confers specifically to the progression of kidney disease. Hence, establishing evidence-based blood pressure targets and treatment strategies is a clinical priority of paramount importance. Over the last few years, different guidelines have advocated different blood pressure treatment thresholds and goals in CKD patients, including a target < 140/90 mmHg and a more intensive target-lower than 130/80 mmHg-in the presence of albuminuria ≥ 300 mg/daily. Aim of this article is to critically appraise the evidence base of the freshly released 2018 ESC/ESH European Guidelines, which recommend to lower systolic BP to a range 130 to < 140 mmHg in patients with diabetic or non-diabetic CKD, also in view of the 2017 US guidelines, which favor a more intensive strategy with a BP target lower than 130/80 mmHg.