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.
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?
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.
CONTEXT: Eighty-five percent of patients with chronic kidney disease (CKD) have hypertension, and blood pressure (BP) control is the cornerstone in the management of CKD. Although it is widely accepted that BP should be optimized, BP targets in CKD are not known. Subject of Review: Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline for the management of BP in CKD (Kidney Int. 2021 Mar 1;99(3S):S1-87) recommends targeting BP to less than 120 mm Hg systolic for patients with CKD. Second Opinion: KDIGO BP target differs from all other hypertension guidelines. This is also a major change from the previous recommendation which was <140 systolic to all patients with CKD and <130 systolic for those with proteinuria. Targeting systolic BP to less than 120 mm Hg is hard to substantiate based on available data and is based primarily on subgroup analysis of a randomized control trial. Intensive BP lowering as suggested by the guidelines may lead to polypharmacy, added cost burden, and risk of serious harms.
Jamale et al. (Sun,) 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.
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