Blood pressure targets in chronic kidney disease: still no consensus

Area of Science:

• Nephrology
• Cardiology
• Hypertension Management

Background:

• Effective hypertension management is crucial for slowing chronic kidney disease (CKD) progression and mitigating cardiovascular event (CVE) risk.
• Historical guidelines recommended a blood pressure (BP) target of <130/80 mmHg for individuals with proteinuria, based on landmark trials.
• Ongoing debate exists regarding optimal BP targets, particularly in light of new evidence and evolving clinical guidelines.

Purpose of the Study:

• To review the evidence supporting different blood pressure (BP) targets in the context of chronic kidney disease (CKD).
• To discuss the controversies surrounding optimal BP targets for CKD management.
• To suggest strategies for improving BP control in patients with CKD.

Main Methods:

• Review of landmark clinical trials and updated guidelines on BP targets for CKD.
• Analysis of evidence regarding the impact of different BP targets on CKD progression and CVE risk.
• Consideration of findings from the Systolic Blood Pressure Intervention Trial (SPRINT).

Main Results:

• Lower BP targets are associated with slower CKD progression, particularly in patients with significant proteinuria.
• The SPRINT trial indicated a reduced CVE risk with a systolic BP target of <120 mmHg, but no significant effect on CKD progression and potential for renal adverse events.
• The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines recommend a systolic BP <120 mmHg, though consensus among all updated guidelines is lacking.

Conclusions:

• Standardized BP measurement is essential for accurate assessment and management.
• An individualized, shared decision-making approach is recommended for setting BP targets and managing hypertension in CKD.
• Personalized strategies are vital for optimizing BP control and patient outcomes in CKD.