Ashish Upadhyay1, Katrin Uhlig. 1. Renal Section, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA.
Abstract
PURPOSE OF REVIEW: Major guidelines recommend a blood pressure (BP) target of less than 130/80 mmHg for patients with chronic kidney disease (CKD) even though the optimal BP target in this population is unclear. This review summarizes the evidence on BP target in CKD and highlights recent pertinent publications. RECENT FINDINGS: Clinical trials in CKD have not definitively shown that setting a BP target that is lower than the standard target of less than 140/90 mmHg provides additional benefit for important clinical outcomes. However, subgroup analyses from the recently published posttrial cohort of the African-American Study of kidney disease and a systematic review of BP target trials in CKD suggest that lower than the standard BP target may be beneficial in patients with proteinuria level of more than 300 or 1000 mg/day. SUMMARY: Evidence supports a BP target of less than 140/90 mmHg in most patients with CKD. A lower target may be chosen in CKD patients with proteinuria after individualized risk-benefit assessment. Treatment to a lower target may require greater vigilance to monitor for and avoid possible symptoms and adverse events from hypotension.
PURPOSE OF REVIEW: Major guidelines recommend a blood pressure (BP) target of less than 130/80 mmHg for patients with chronic kidney disease (CKD) even though the optimal BP target in this population is unclear. This review summarizes the evidence on BP target in CKD and highlights recent pertinent publications. RECENT FINDINGS: Clinical trials in CKD have not definitively shown that setting a BP target that is lower than the standard target of less than 140/90 mmHg provides additional benefit for important clinical outcomes. However, subgroup analyses from the recently published posttrial cohort of the African-American Study of kidney disease and a systematic review of BP target trials in CKD suggest that lower than the standard BP target may be beneficial in patients with proteinuria level of more than 300 or 1000 mg/day. SUMMARY: Evidence supports a BP target of less than 140/90 mmHg in most patients with CKD. A lower target may be chosen in CKDpatients with proteinuria after individualized risk-benefit assessment. Treatment to a lower target may require greater vigilance to monitor for and avoid possible symptoms and adverse events from hypotension.
Authors: Myra A Carpenter; Alin John; Matthew R Weir; Stephen R Smith; Lawrence Hunsicker; Bertram L Kasiske; John W Kusek; Andrew Bostom; Anastasia Ivanova; Andrew S Levey; Scott Solomon; Todd Pesavento; Daniel E Weiner Journal: J Am Soc Nephrol Date: 2014-03-13 Impact factor: 10.121