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Blood pressure control in chronic kidney disease: is less really more?

Julia B Lewis1

  • 1Division of Nephrology and Hypertension, Department of Medicine, S-2332 Medical Center North, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-2372, USA. julia.lewis@vanderbilt.edu

Journal of the American Society of Nephrology : JASN
|June 26, 2010
PubMed

Insights

Blood pressure control is vital for chronic kidney disease patients. Current guidelines suggest a goal of <130/80 mmHg, but benefits require further confirmation from ongoing trials.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Clinical Hypertension

Background:

  • Blood pressure (BP) management is crucial for patients with chronic kidney disease (CKD).
  • Recent guidelines advocate for a stringent BP target of less than 130/80 mmHg for CKD patients.
  • The evidence supporting this specific BP goal primarily stems from observational data and subgroup analyses, not definitive randomized trials.

Purpose of the Study:

  • To evaluate the established benefits of the <130/80 mmHg blood pressure goal in chronic kidney disease.
  • To explore potential adverse events associated with achieving very low blood pressure levels in CKD patients.

Main Methods:

  • Review of existing clinical trial data, focusing on randomized, intention-to-treat studies.
  • Analysis of observational data and secondary/subgroup findings that informed current guidelines.
  • Consideration of emerging evidence regarding potential risks of intensive BP lowering.

Main Results:

  • Randomized controlled trials have not conclusively demonstrated the benefits of the <130/80 mmHg BP target in CKD.
  • Observational studies and subgroup analyses were key drivers for the updated guideline recommendations.
  • Preliminary observations suggest potential risks associated with achieving excessively low BP in this population.

Conclusions:

  • The clinical benefits of the <130/80 mmHg BP goal in chronic kidney disease remain to be definitively established by robust randomized trials.
  • Further research, including ongoing randomized trials, is necessary to ascertain the true benefits and risks of intensive blood pressure management in CKD.
  • A careful balance is needed to optimize BP control while mitigating potential adverse effects in CKD patients.

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