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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Blood pressure parameters and morbid and mortal outcomes in nondialysis-dependent chronic kidney disease

Carl P Walther1, Aravind Chandra2, Sankar D Navaneethan1,3

  • 1Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine.

Current Opinion in Nephrology and Hypertension
|October 19, 2017
PubMed

Insights

Lowering blood pressure (BP) to below 120 mmHg in chronic kidney disease (CKD) patients may reduce mortality. However, observational studies show low BP is linked to higher mortality, highlighting the need for careful therapeutic decisions.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Trials

Background:

  • Conflicting evidence exists on optimal blood pressure (BP) control for chronic kidney disease (CKD) patients.
  • Recent studies offer new insights for managing BP in CKD.

Purpose of the Study:

  • To review and summarize observational and interventional literature on BP parameters and clinical outcomes in CKD.
  • To reconcile discrepancies between observational and interventional study findings.

Main Methods:

  • Systematic review of observational and interventional studies on BP in CKD.
  • Analysis of meta-analyses concerning BP management in non-dialysis-dependent CKD patients.
  • Examination of factors influencing the BP-mortality association.

Main Results:

  • Targeting systolic BP (SBP) <120 mmHg, versus <140 mmHg, reduced cardiovascular events and mortality in non-diabetic CKD.
  • Intensive BP lowering therapies generally reduced mortality across subgroups in a meta-analysis.
  • Observational studies indicate low SBP is associated with higher mortality, while high BP is linked to cardiovascular death.

Conclusions:

  • Disparate findings may stem from differences in patient characteristics and BP measurement techniques between study designs.
  • Therapeutic decision-making for BP control in CKD requires careful consideration of study design and patient factors.
Abstract

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