Blood pressure targets and kidney and cardiovascular disease: same data but discordant guidelines

Area of Science:

• Nephrology
• Cardiology
• Hypertension Research

Background:

• Hypertension is prevalent in the United States and a major risk factor for cardiovascular disease.
• Hypertension is common in chronic kidney disease (CKD), contributing to the CKD-cardiovascular disease association.
• The optimal systolic blood pressure (BP) target for reducing cardiovascular disease risk in CKD patients remains controversial.

Purpose of the Study:

• To review recent guidelines and findings on hypertension management in CKD.
• To discuss the impact of studies like SPRINT and ACCORD-BP on BP targets.
• To summarize the current understanding of BP targets' effects on mortality and kidney outcomes in CKD.

Main Methods:

• Review of recent hypertension guidelines from various societies.
• Analysis of post-hoc data from the Systolic Blood Pressure Intervention Trial (SPRINT).
• Examination of subgroup analyses from the ACCORD-BP trial.

Main Results:

• New guidelines offer differing BP targets, influenced by SPRINT's suggested mortality benefit with intensive BP control.
• Post-hoc analyses of ACCORD-BP suggest benefits of tighter BP control for mortality but also indicate potential harm to kidney outcomes.
• Lower target BP is associated with reduced mortality in CKD patients.

Conclusions:

• While lower BP targets may decrease mortality in CKD, their long-term impact on kidney function requires further investigation.
• Hypertension treatment in CKD should be individualized, considering cardiovascular risk, medication tolerance, and patient goals.
• The optimal systolic BP target for CKD patients remains an area of ongoing research and clinical debate.