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Updated: May 23, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Is the lower blood pressure target for patients with chronic kidney disease supported by evidence?
Ashish Upadhyay1, Katrin Uhlig
1Renal Section, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA.
Insights
The optimal blood pressure (BP) target for chronic kidney disease (CKD) patients remains unclear. While a standard BP target of less than 140/90 mmHg is generally supported, lower targets may benefit proteinuric CKD patients after careful assessment.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Trials
Background:
- Current guidelines suggest a blood pressure (BP) target below 130/80 mmHg for patients with chronic kidney disease (CKD).
- However, the optimal BP target for this specific patient group remains uncertain.
- This review synthesizes existing evidence and recent studies regarding BP targets in CKD.
Purpose of the Study:
- To review and summarize the evidence on blood pressure targets in patients with chronic kidney disease (CKD).
- To highlight recent publications relevant to BP management in CKD.
- To clarify the optimal BP target for CKD patients.
Main Methods:
- Systematic review of clinical trials and cohort studies.
- Analysis of subgroup data from the African-American Study of Kidney Disease.
- Evaluation of evidence on BP targets in CKD populations.
Main Results:
- Clinical trials have not conclusively demonstrated benefits of BP targets below 140/90 mmHg for major outcomes in CKD.
- Subgroup analyses suggest potential benefits of lower BP targets in CKD patients with proteinuria exceeding 300 or 1000 mg/day.
- Evidence indicates a standard BP target of <140/90 mmHg is appropriate for most CKD patients.
Conclusions:
- A BP target of less than 140/90 mmHg is supported by evidence for the majority of CKD patients.
- Individualized risk-benefit assessment is recommended for considering lower BP targets in CKD patients with proteinuria.
- Vigilant monitoring for hypotension and adverse events is crucial when implementing lower BP targets.
Purpose Of Review:
Major guidelines recommend a blood pressure (BP) target of less than 130/80 mmHg for patients with chronic kidney disease (CKD) even though the optimal BP target in this population is unclear. This review summarizes the evidence on BP target in CKD and highlights recent pertinent publications.
Recent Findings:
Clinical trials in CKD have not definitively shown that setting a BP target that is lower than the standard target of less than 140/90 mmHg provides additional benefit for important clinical outcomes. However, subgroup analyses from the recently published posttrial cohort of the African-American Study of kidney disease and a systematic review of BP target trials in CKD suggest that lower than the standard BP target may be beneficial in patients with proteinuria level of more than 300 or 1000 mg/day.
Summary:
Evidence supports a BP target of less than 140/90 mmHg in most patients with CKD. A lower target may be chosen in CKD patients with proteinuria after individualized risk-benefit assessment. Treatment to a lower target may require greater vigilance to monitor for and avoid possible symptoms and adverse events from hypotension.
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