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KDOQI US Commentary on the 2017 ACC/AHA Hypertension Guideline
Holly J Kramer1, Raymond R Townsend2, Karen Griffin3
1Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood; Department of Medicine, Loyola University Chicago Stritch School of Medicine, Maywood; Hines VA Medical Center, Hines, IL.
Insights
This commentary reviews hypertension guidelines for chronic kidney disease (CKD) patients, excluding dialysis. It supports most recommendations but highlights areas needing further research for optimal blood pressure management in CKD.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Management
Background:
- Hypertension is a key risk factor for cardiovascular disease and kidney disease progression.
- Blood pressure targets for antihypertensive medication initiation and titration have been debated.
- The 2017 ACC/AHA hypertension guidelines offer recommendations relevant to nephrology but exclude dialysis patients.
Purpose of the Study:
- To provide a commentary on the 2017 ACC/AHA hypertension guidelines for individuals at risk of or with non-dialysis-dependent CKD.
- To discuss relevant aspects of European guidelines for hypertension management in adults receiving maintenance dialysis.
- To highlight areas of controversy in hypertension diagnosis and treatment for CKD patients.
Main Methods:
- Review and commentary on the 2017 ACC/AHA hypertension guidelines.
- Inclusion of a discussion on the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and European Society of Hypertension consensus statement.
- Focus on recommendations pertinent to non-dialysis-dependent CKD and individuals at risk.
Main Results:
- General support for the majority of the ACC/AHA hypertension guideline recommendations.
- Identification of specific areas where optimal diagnosis and treatment strategies remain controversial.
- Discussion of hypertension management in dialysis patients based on European consensus statements.
Conclusions:
- The commentary largely endorses the ACC/AHA guidelines for non-dialysis CKD populations.
- Further research and discussion are needed for controversial aspects of hypertension management in CKD.
- Integrated consideration of guidelines from multiple professional societies is crucial for comprehensive care.
Abstract:
Hypertension is a modifiable risk factor for cardiovascular morbidity and mortality and reduction of elevated blood pressure (BP) remains an important intervention for slowing kidney disease progression. Over the past decade, the most appropriate BP target for initiation and titration of BP-lowering medications has been an area of intense research and debate within the clinical community. In 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) in conjunction with several other professional societies released new hypertension guidelines based on data from a systematic review of clinical trials and observational data. While many of the recommendations in the ACC/AHA hypertension guideline are relevant to nephrology practice, BP targets and management strategies for patients receiving dialysis are not discussed. This Kidney Disease Outcomes Quality Initiative (KDOQI) commentary focuses largely on recommendations from the ACC/AHA hypertension guidelines that are pertinent to individuals at risk of chronic kidney disease or with non-dialysis-dependent chronic kidney disease. This KDOQI commentary also includes a brief discussion of the consensus statement regarding hypertension diagnosis and management for adults receiving maintenance dialysis published by the European Renal and Cardiovascular Medicine Working Group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension. Overall, we support the vast majority of the ACC/AHA recommendations and highlight select areas in which best diagnosis and treatment options remain controversial.
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