Antihypertensive therapy in nondiabetic chronic kidney disease: a review and update

Area of Science:

• Nephrology
• Cardiology
• Internal Medicine

Background:

• Hypertension is a key driver of progressive nondiabetic chronic kidney disease (CKD).
• Deviations from ideal blood pressure (BP) ranges increase risks for mortality, cardiovascular events, and renal disease progression.
• Existing trials on strict vs. less intensive BP control in CKD lack conclusive evidence for renal benefits, except possibly in proteinuric subgroups.

Purpose of the Study:

• To comprehensively review antihypertensive literature for nondiabetic renal disease.
• To emphasize the impact of blood pressure targets on CKD progression.
• To evaluate if intensive BP control benefits extend to CKD patients, mirroring benefits seen in high cardiovascular risk populations.

Main Methods:

• Systematic review of clinical trials and meta-analyses concerning BP control in nondiabetic CKD.
• Analysis of observational data linking BP variability to adverse outcomes.
• Focus on studies comparing different BP targets and their effects on renal and cardiovascular health.

Main Results:

• No consistent renal advantage demonstrated for strict BP control over less intensive approaches in nondiabetic CKD.
• Circumstantial evidence suggests potential benefits in proteinuric patients.
• Growing interest in intensive BP control for CKD, spurred by findings in high cardiovascular risk groups.

Conclusions:

• The optimal BP target for nondiabetic CKD remains debated, with no clear renal superiority of strict control.
• Further research is needed to clarify benefits in specific CKD subgroups, particularly those with proteinuria.
• The potential for intensive BP management to improve outcomes in CKD warrants continued investigation.