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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

Blood pressure goal in chronic kidney disease: what is the evidence?

Rajiv Agarwal1

  • 1Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana 46202, USA. ragarwal@iupui.edu

Current Opinion in Nephrology and Hypertension
|March 2, 2011
PubMed

Insights

For patients with chronic kidney disease (CKD), a blood pressure (BP) goal of less than 130/80 mmHg is not supported by current evidence. A less stringent BP target may be appropriate for most individuals with CKD.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Management

Background:

  • Current guidelines recommend a seated clinic blood pressure (BP) target of <130/80 mmHg for patients with chronic kidney disease (CKD).
  • The evidence supporting this stringent BP target in CKD populations requires critical evaluation.

Purpose of the Study:

  • To review the evidence underlying the recommended BP targets for patients with CKD.
  • To assess whether a BP goal of <130/80 mmHg offers significant benefits in CKD patients.

Main Methods:

  • Analysis of randomized controlled trials (RCTs) examining BP targets in CKD patients.
  • Focus on trials prospectively investigating the optimal level of BP reduction.

Main Results:

  • Three RCTs exclusively in CKD patients showed that a BP goal of <130/80 mmHg did not improve survival or protect kidney and cardiovascular health compared to less aggressive goals.
  • The evidence supporting a <130/80 mmHg BP target in CKD is limited.

Conclusions:

  • A BP goal of <140/90 mmHg is reasonable for most patients with CKD.
  • More aggressive BP lowering (<130/80 mmHg) is not strongly supported by current data.
  • Individualized hypertension therapy, potentially utilizing home BP monitoring, is recommended for CKD patients.
Abstract

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