Target blood pressure for antihypertensive therapy in patients with proteinuric renal disease.

The Modification of Diet in Renal Disease (MDRD) study showed for the first time that controlling blood pressure is critically important in slowing the progression of proteinuric renal disease (24-h proteinuria of 1.0 g or more). Furthermore, it was found that the greater proteinuria, the more important it was to achieve excellent blood pressure control. The MDRD analysis also suggested that this paradigm may be particularly important for blacks with proteinuric renal disease. Surprisingly, the MDRD data showed that a blood pressure of 125/75 mm Hg was superior to a blood pressure of 135/85 mm Hg in slowing the progression of renal disease. Thus, so-called hypercontrol of blood pressure is needed to slow the progression of proteinuric renal disease. Studies in patients with diabetic glomerulosclerosis also have provided evidence as to the importance of achieving the low blood pressure goal to slow the progression of the glomerulopathy. In summary, strict control of blood pressure (125/75 mm Hg or less, if tolerated) is recommended to slow the progression of proteinuric renal disease. Furthermore, the greater the proteinuria, the more important it is to achieve this target blood pressure to slow the progression of renal disease.