The 2018 ESC/ESH hypertension guidelines: Should nephrologists always stop at the lower boundary?

Area of Science:

• Nephrology
• Cardiology
• Hypertension Management

Background:

• Hypertension is a significant complication in chronic kidney disease (CKD), increasing cardiovascular risks and accelerating kidney disease progression.
• Current guidelines offer varying blood pressure (BP) targets for CKD patients, with some recommending <140/90 mmHg and others a more intensive <130/80 mmHg, especially with albuminuria.
• Establishing evidence-based BP targets is a clinical priority for managing CKD patients.

Discussion:

• This article critically appraises the 2018 ESC/ESH European Guidelines for hypertension management in CKD.
• It compares the European guidelines' recommendation of systolic BP 130 to <140 mmHg with the 2017 US guidelines' more intensive target of <130/80 mmHg.
• The discussion focuses on the evidence base supporting these differing BP targets in diabetic and non-diabetic CKD patients.

Key Insights:

• The 2018 ESC/ESH guidelines suggest a systolic BP target of 130 to <140 mmHg for CKD patients.
• The 2017 US guidelines advocate for a more intensive BP target (<130/80 mmHg).
• Discrepancies in guideline recommendations highlight ongoing debate in optimal hypertension management for CKD.

Outlook:

• Further research is needed to clarify the optimal BP targets for diverse CKD populations.
• Comparative studies evaluating the long-term outcomes of different BP targets are essential.
• Future guidelines may achieve greater consensus based on emerging evidence.