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Blood pressure target for hypertension in chronic kidney disease: One size does not fit all

Anastasios Kollias1, Konstantinos G Kyriakoulis1, George S Stergiou1

  • 1Hypertension Center STRIDE-7, National and Kapodistrian University of Athens, School of Medicine, Third Department of Medicine, Sotiria Hospital, Athens, Greece.

Journal of Clinical Hypertension (Greenwich, Conn.)
|May 4, 2020
PubMed

Insights

Guidelines differ on blood pressure targets for hypertensive chronic kidney disease (CKD) patients. Intensive targets may benefit only those with proteinuria, suggesting personalized treatment is crucial.

Area of Science:

  • Nephrology
  • Cardiology
  • Clinical Hypertension

Background:

  • Conflicting guidelines exist for managing hypertension in chronic kidney disease (CKD) patients.
  • Current evidence does not uniformly support intensive blood pressure targets for all CKD hypertensive patients.

Purpose of the Study:

  • To analyze the optimal blood pressure target for patients with chronic kidney disease and hypertension.
  • To evaluate the role of proteinuria in determining blood pressure management strategies for CKD.

Main Methods:

  • Review of randomized clinical trials and meta-analyses of individual patient data.
  • Analysis of evidence regarding intensive versus standard blood pressure control in CKD.
  • Consideration of proteinuria as a factor in treatment decisions.

Main Results:

  • No clear support for intensive blood pressure targets across the entire CKD hypertensive population.
  • Evidence suggests potential renal benefits from strict blood pressure control in proteinuric CKD patients.

Conclusions:

  • A tailored treatment strategy is essential for hypertensive CKD patients.
  • Individualized approaches should consider proteinuria and treatment tolerability.
  • Standardized blood pressure measurement, including out-of-office monitoring, is critical.

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