Blood pressure control in chronic kidney disease: is less really more?

BP control is critical in the treatment of patients with chronic kidney disease. Recent guidelines now recommend a BP goal of <130/80 mmHg. Clinical trials using a randomized, intention-to-treat design have not established the benefits of this goal; rather, observational data and secondary or subgroup analyses drove the development of the new guidelines. A variety of observations suggest potential adverse events associate with achieving too low a BP in patients with chronic kidney disease, and ongoing randomized trials will have to establish the benefits or risks of meeting this goal.