Control of blood pressure in chronic kidney disease: how low to go?

Blood pressure (BP) lowering is an important therapeutic goal in patients with diabetic and non-diabetic chronic kidney disease (CKD) for slowing progression and preventing onset of cardiovascular disease. The guidelines for treatment of hypertension in patients with CKD recommend a target BP <130/80 mm Hg, with no clear threshold on the lower limit. However, results of recent randomized controlled trials on CKD indicate that aggressive lowering of BP may not provide additional benefit in the vast majority of patients. This paper will review the literature on the main trials examining the question concerning the optimal level of target BP in patients with CKD and also discuss reasonable target BP levels in light of the evidence, as well as future direction for research in such patients.