Blood pressure targets and kidney and cardiovascular disease: same data but discordant guidelines.

PURPOSE OF REVIEW: Hypertension is highly prevalent in the United States and a major risk factor for the development of cardiovascular disease. Hypertension is common in chronic kidney disease (CKD), and likely contributes to the association between CKD and cardiovascular disease. The ideal systolic BP to reduce cardiovascular disease risk in individuals with CKD is controversial. RECENT
FINDINGS: Several societies have released guidelines on the treatment of hypertension in the past year, each differing in important aspects, including BP targets. The release of new guidelines was largely spurred by the results of Systolic Blood Pressure Intervention Trial (SPRINT), which suggested mortality benefit with more intensive BP targets. Recent post-hoc analyses of a subgroup of ACCORD-BP participants suggest a benefit with tighter BP control. However, another post-hoc analysis of ACCORD-BP participants showed worse kidney outcomes with tighter BP control.
SUMMARY: Lower target BP appears associated with lower mortality in CKD, although longer term benefits with regard to kidney function remain unclear. Within this framework, treatment of hypertension should be tailored to each individual patient, accounting for cardiovascular disease risk, medication tolerance, and individual patient goals.