Related Experiment Video
Updated: Dec 19, 2025
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Review - current opinion in cardiology hypertension in chronic kidney disease
Muhannad Alqudsi1,2, Swapnil Hiremath3, Juan Carlos Q Velez1,2
1Department of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.
Insights
Optimal blood pressure targets for patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) remain unclear. Current evidence from large trials is limited, necessitating further research for definitive hypertension management guidelines.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Hypertension significantly increases risks for cardiovascular disease, stroke, and end-stage kidney disease (ESKD).
- Kidneys are implicated in hypertension development and are susceptible to hypertensive damage.
- Optimal blood pressure (BP) goals for patients with chronic kidney disease (CKD) and ESKD are not well-defined.
Purpose of the Study:
- To critically review the existing evidence regarding optimal blood pressure goals in CKD and ESKD patients.
- To highlight the current gaps in understanding hypertension management in kidney disease.
Main Methods:
- Review of large randomized controlled trials (RCTs) and relevant literature.
- Analysis of data from trials such as the Systolic Blood Pressure Intervention Trial (SPRINT) and the Blood Pressure in Dialysis Trial.
Main Results:
- Large RCTs are considered the gold standard for evidence but provide limited definitive conclusions for BP goals in CKD/ESKD.
- Few adequately powered RCTs specifically address hypertension treatment targets in CKD.
- Evidence for optimal BP goals in ESKD patients is even scarcer, with small pilot studies being hypothesis-generating.
Conclusions:
- Effective hypertension management in CKD is crucial for cardiovascular, cerebrovascular, and renal outcomes.
- Current evidence is insufficient to establish ideal blood pressure control targets for patients with CKD and ESKD.
Purpose Of Review:
Hypertension is a major risk factor for cardiovascular disease, cerebrovascular events, and progression to end-stage kidney disease (ESKD). The kidneys play a causative role in hypertension, but they are also organs vulnerable to hypertensive injury. Thus far, goals for optimal blood pressure in chronic kidney disease (CKD) and ESKD patients are not fully elucidated. Herein, we critically review the existing evidence.
Recent Findings:
Large randomized controlled trials (RCTs) continue to be deemed as the best source of evidence to guide optimal blood pressure goals in CKD and ESKD patients. Despite recent advances, the growing body of literature does not permit drawing definitive conclusions. Few adequately powered RCTs have specifically assessed goals for treatment of hypertension in patients with CKD. The most recent large RCT in hypertension, the Systolic Blood Pressure Intervention Trial, included a subset of patients with CKD and provided some insights. For the ESKD population, trials to evaluate blood pressure goals are even more scarce. The Blood Pressure in Dialysis Trial was a relatively small pilot study that can be deemed as hypothesis generating.
Summary:
Management of hypertension in CKD is essential for optimization of cardiovascular, cerebrovascular and renal outcomes. To date, the existing evidence does not fully clarify ideal targets for blood pressure control in this patient population.
