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What should be the goal blood pressure in nondiabetic chronic kidney disease?
Markus P Schneider1, Karl F Hilgers
1Department of Nephrology and Hypertension, University of Erlangen-Nuremberg, Erlangen, Germany.
Insights
A lower blood pressure goal may preserve kidney function in nondiabetic chronic kidney disease (CKD) patients with significant proteinuria. However, current evidence does not support a lower target for all CKD patients or for preventing cardiovascular events.
Area of Science:
- Nephrology
- Cardiology
- Clinical Trials
Background:
- Nondiabetic chronic kidney disease (CKD) affects renal function and increases cardiovascular risk.
- Optimizing blood pressure (BP) management is crucial for CKD patients.
Purpose of the Study:
- To review evidence on lower BP targets in nondiabetic CKD.
- To assess BP targets for slowing CKD progression and preventing cardiovascular events.
Main Methods:
- Review of prospective, randomized controlled trials.
- Analysis of subgroup data from cardiovascular trials.
Main Results:
- Lower BP target (<130/80 mmHg) may preserve renal function in CKD patients with proteinuria (>300 mg/day).
- Evidence for lower BP targets in CKD is inconclusive.
- No clear benefit of lower BP targets for cardiovascular event prevention in CKD was found.
Conclusions:
- No convincing evidence supports a BP target <140/90 mmHg for all nondiabetic CKD patients.
- A BP target <130/80 mmHg might benefit only CKD patients with proteinuria.
- Further research is needed for cardiovascular event prevention in CKD.
Purpose Of Review:
To summarize the available evidence on whether a lower blood pressure (BP) treatment target can ameliorate the progression of nondiabetic chronic kidney disease (CKD), and prevent cardiovascular events in CKD patients.
Recent Findings:
The three prospective, randomized controlled trials which addressed the question of progression of CKD suggest that a lower BP treatment goal (<130/80 mmHg) may lead to better preservation of renal function, but only in those patients with proteinuria of more than 300 mg/day. However, the evidence is not conclusive. We are not aware of adequately powered, randomized trials that have assessed the efficacy of lower target BP levels for the prevention of cardiovascular events specifically in nondiabetic CKD patients. The available circumstantial evidence (e.g., subgroup analyses of CKD patients in cardiovascular trials) fails to reveal a clear benefit of a lower BP goal.
Summary:
There is currently no convincing evidence to recommend a lower than standard BP treatment target of less than 140/90 mmHg for all patients with nondiabetic CKD. A lower treatment target of less than 130/80 mmHg may delay renal disease progression but only in patients with proteinuria.
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