Related Experiment Video
Updated: May 10, 2026
Improved Home Blood Pressure Control by CT-guided Ozone-mediated Renal Denervation for Patients with Resistant Hypertension
Published on: June 6, 2025
What should be the blood pressure target for patients with chronic kidney disease?
Susanne B Nicholas1, Nosratola D Vaziri, Keith C Norris
1Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
Insights
For individuals with chronic kidney disease (CKD) and hypertension, maintaining blood pressure (BP) below 140/90 mmHg is recommended. Specific patient groups may benefit from lower BP targets and combined therapies like diuretics and ARBs or ACEIs.
Area of Science:
- Nephrology
- Cardiology
- Clinical Trials
Background:
- Chronic kidney disease (CKD) patients face a high risk of elevated blood pressure (BP), leading to premature end-stage renal disease and cardiovascular events.
- Hypertension management is critical in CKD to mitigate associated complications.
Purpose of the Study:
- To review current evidence on optimal blood pressure targets in patients with chronic kidney disease.
- To evaluate the efficacy of different antihypertensive medication classes and combinations in CKD.
Main Methods:
- Analysis of recent randomized controlled clinical trials.
- Evaluation of clinical outcomes based on systolic blood pressure (SBP) and diastolic blood pressure (DBP) thresholds.
- Assessment of treatment strategies in CKD patients with varying levels of proteinuria.
Main Results:
- Optimal outcomes for most CKD patients with hypertension are achieved with SBP < 140 mmHg and DBP < 90 mmHg.
- Lowering BP to SBP < 130 mmHg and DBP < 80 mmHg shows controversial benefits, primarily for CKD patients with proteinuria (>300 mg/day).
- Combination therapy with a diuretic and an angiotensin receptor blocker (ARB) or angiotensin-converting enzyme inhibitor (ACEI) shows promise for CKD patients with proteinuria.
Conclusions:
- A practical clinical approach for elevated BP in CKD is to target BP < 140/90 mmHg using a diuretic combined with an ARB or ACEI.
- Individualized BP goals and interventions should consider CKD etiology, proteinuria presence, and comorbidities.
- Further consideration for lower BP targets and alternative therapies is warranted based on patient-specific factors.
Purpose Of Review:
Persons with chronic kidney disease (CKD) exhibit a disproportionate burden of elevated blood pressure (BP) with a high prevalence of premature end-stage renal disease and cardiovascular events.
Recent Findings:
Results of recent randomized controlled clinical trials suggest that most patients with reduced estimated glomerular filtration rate (eGFR) and hypertension experience optimal clinical outcomes when SBP is less than 140 mmHg and DBP is less than 90 mmHg. The benefit of additional lowering of SBP to less than 130 mmHg and DBP to less than 80 mmHg remains controversial, and appears to be of most benefit to the subset of CKD patients with proteinuria (>300 mg/day). The combination of a diuretic and an angiotensin receptor blocker (ARB) or angiotensin-converting enzyme inhibitor (ACEI) has demonstrated particular promise in patients with reduced eGFR and proteinuria.
Summary:
A practical approach in clinical practice for the treatment of elevated BP in persons with CKD is to achieve a BP less than 140/90 mmHg with a combination of diuretic and an ARB or ACEI. Consideration for a lower BP goal and other therapeutic and nontherapeutic interventions can be made based on the cause of CKD, presence of proteinuria, or other coexisting medical conditions.
Related Concept Videos
01:28Chronic Kidney Disease III: Interprofessional Care
01:25Chronic Kidney Disease I: Introduction
01:18Chronic Kidney Disease IV: Nursing Management
01:24Chronic Kidney Disease II: Clinical Manifestations
01:18Hypertension and Regulation of Blood Pressure
01:22Acute Kidney Injury VI: Nursing Management