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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

[Limitations of blood pressure target in non-dialysis chronic kidney disease: a question of method?]

Silvio Borrelli1, Luca De Nicola, Roberto Minutolo

  • 1Cattedra di Nefrologia, Seconda Universita' di Napoli, Italy. drsilvioborrelli@gmail.com

Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia
|July 31, 2012
PubMed

Insights

International guidelines suggest blood pressure (BP) below 130/80 mmHg for chronic kidney disease (CKD) patients. Ambulatory blood pressure monitoring (ABPM) may better predict outcomes than clinic BP readings.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Research

Context:

  • Current international guidelines recommend a blood pressure (BP) target below 130/80 mmHg for non-dialysis chronic kidney disease (CKD) patients.
  • This recommendation is primarily based on observational and post-hoc analyses, lacking validation from randomized controlled trials.
  • Office BP readings may not accurately assess risk in CKD patients due to common BP profile alterations like white-coat hypertension and nocturnal hypertension.

Purpose:

  • To evaluate the prognostic significance of BP targets in CKD patients.
  • To highlight the limitations of office BP measurements in CKD.
  • To advocate for the increased use of ambulatory blood pressure monitoring (ABPM) in CKD management.

Summary:

  • The established BP target for CKD patients lacks robust randomized trial support.
  • Office BP measurements are insufficient for risk stratification in CKD due to variations like white-coat and nighttime hypertension.
  • Ambulatory blood pressure monitoring (ABPM) demonstrates superior predictive value for renal and cardiovascular events compared to clinic BP.

Impact:

  • Suggests that ABPM is a more reliable tool for risk stratification and management of hypertension in CKD.
  • Emphasizes the need for further research, including the ongoing SPRINT trial, to refine BP management strategies in CKD.
  • Recommends wider adoption of ABPM in clinical practice for improved patient outcomes in CKD.

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