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How Low Do We Go (in the Post-SPRINT Era)?

Anna Burgner1, Julia B Lewis1

  • 1Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, TN.

Advances in Chronic Kidney Disease
|April 27, 2019
PubMed

Insights

Determining the optimal blood pressure target for chronic kidney disease (CKD) patients remains debated. This review analyzes key trial data to guide evidence-based recommendations for managing hypertension in CKD.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Clinical Trials

Background:

  • Hypertension is a significant cause and complication of chronic kidney disease (CKD).
  • Establishing the ideal blood pressure target for CKD patients has been a long-standing clinical debate with limited guiding data.
  • CKD management often involves addressing comorbid hypertension.

Purpose of the Study:

  • To review existing clinical trial data to inform optimal blood pressure targets in patients with CKD.
  • To analyze evidence from major trials like SPRINT, MDRD, AASK, REIN-2, and ACCORD.
  • To address the clinical question regarding the lowest safe and effective blood pressure goal for CKD patients.

Main Methods:

  • Systematic review of data from landmark clinical trials.
  • Analysis of evidence from the Systolic Blood Pressure Intervention Trial (SPRINT).
  • Inclusion of data from Modification of Diet in Renal Disease (MDRD), African American Study of Kidney Disease and Hypertension (AASK), Ramipril Efficacy in Nephropathy-2 (REIN-2), and Action to Control Cardiovascular Risk in Diabetes (ACCORD) trials.

Main Results:

  • Evidence synthesis from multiple large-scale clinical trials provides insights into blood pressure management in CKD.
  • Analysis suggests potential benefits of lower blood pressure targets in specific CKD populations.
  • Data interpretation aims to resolve the ongoing debate on optimal hypertension control in CKD.

Conclusions:

  • The review of SPRINT, MDRD, AASK, REIN-2, and ACCORD trials offers critical evidence for setting blood pressure goals in CKD.
  • Findings aim to guide clinicians in making informed decisions about hypertension management for patients with chronic kidney disease.
  • Further research and consensus are needed to definitively establish the "how low should we go?" target for blood pressure in CKD.

Keywords:
Cardiovascular diseaseChronic kidney diseaseHypertensionSPRINTSystolic blood pressure

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