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Blood pressure control in patients with chronic kidney disease

Jee Young Lee1, Seung Hyeok Han1

  • 1Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Korea.

The Korean Journal of Internal Medicine
|June 21, 2021
PubMed

Insights

Achieving optimal blood pressure (BP) control is crucial for patients with chronic kidney disease (CKD). While lower BP targets reduce cardiovascular events, the optimal BP goal for CKD patients remains debated, especially for advanced stages.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Management

Background:

  • Uncontrolled blood pressure (BP) in chronic kidney disease (CKD) patients elevates risks of cardiovascular events (CVEs) and end-stage kidney disease.
  • The Systolic Blood Pressure Intervention Trial (SPRINT) influenced a paradigm shift towards lower systolic BP (SBP) targets, now recommended by KDIGO 2021 guidelines.
  • Controversy exists regarding intensive SBP control (< 120 mmHg) in CKD patients, with potential risks to kidney outcomes.

Purpose of the Study:

  • To review the optimal BP control strategies for CKD patients.
  • To evaluate the benefits of BP management in reducing mortality and CVEs.
  • To assess the impact of BP control on attenuating CKD progression.

Main Methods:

  • Literature review of evidence-based studies on BP management in CKD.
  • Analysis of randomized controlled trials and observational data.
  • Discussion of SPRINT and KDIGO guidelines in the context of CKD.

Main Results:

  • Lower SBP targets (< 120 mmHg) show potential for reducing CVEs in the general population.
  • The efficacy and safety of intensive SBP control (< 120 mmHg) specifically in CKD patients, particularly advanced CKD, require further investigation.
  • Current evidence is limited by a lack of dedicated randomized controlled trials in CKD populations.

Conclusions:

  • Optimal BP control is essential for managing CKD complications, including CVEs and CKD progression.
  • While lower SBP targets are beneficial, the specific target for CKD patients needs careful consideration due to potential adverse kidney outcomes.
  • Further research, especially RCTs in CKD populations, is needed to establish definitive BP targets.

Keywords:
Blood pressureChronic renal insufficiencyRenal insufficiency, chronic

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