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Antihypertensive treatment and renal protection: Is there a J-curve relationship?

Francesca Viazzi1, Giovanna Leoncini1, Guido Grassi2,3

  • 1Ospedale Policlinico San Martino, Università degli Studi and I.R.C.C.S, Genoa, Italy.

Journal of Clinical Hypertension (Greenwich, Conn.)
|September 30, 2018
PubMed

Insights

Optimal blood pressure (BP) targets are crucial for managing kidney disease. Evidence suggests a systolic BP around 130 mmHg offers both kidney and cardiovascular protection, with lower targets potentially beneficial for those with proteinuria.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Management

Background:

  • Hypertension and kidney disease share a bidirectional, exacerbating relationship.
  • Elevated blood pressure (BP) is a key modifiable risk factor for cardiovascular disease and chronic kidney disease progression.

Purpose of the Study:

  • To identify optimal blood pressure targets for renal patients.
  • To evaluate the BP-renal function J-curve relationship in managing kidney disease.

Main Methods:

  • Review of recent large clinical trials and real-life cohort studies.
  • Analysis of evidence regarding blood pressure thresholds for renal and cardiovascular protection.

Main Results:

  • Renal protection appears to plateau below a certain BP threshold.
  • Very low BP levels may paradoxically increase renal morbidity, suggesting a J-curve relationship.
  • A systolic BP target of approximately 130 mmHg is supported for combined renal and cardiovascular protection.

Conclusions:

  • Existing evidence supports a systolic BP target of around 130 mmHg for optimal renal and cardiovascular outcomes in hypertensive kidney disease patients.
  • Lower BP targets may be considered for patients with overt proteinuria.
  • Further research into the BP-renal function J-curve is warranted.

Keywords:
J-curve relationshipRAAS-inhibitionalbuminuriachronic kidney diseaseglomerular filtration ratehypertensiontarget blood pressure

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