Debbie C Chen1, Wendy McCallum2, Mark J Sarnak2, Elaine Ku3,4,5. 1. Division of Nephrology, Department of Medicine, University of California San Francisco, 533 Parnassus Ave, U404, San Francisco, CA, 94143-0532, USA. debbie.chen@ucsf.edu. 2. Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA, USA. 3. Division of Nephrology, Department of Medicine, University of California San Francisco, 533 Parnassus Ave, U404, San Francisco, CA, 94143-0532, USA. 4. Division of Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA. 5. Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
Abstract
PURPOSE OF REVIEW: Acute declines in estimated glomerular filtration rate (eGFR) are often observed during intensive blood pressure (BP) lowering. This review focuses on identifying the various mechanisms of eGFR decline associated with intensive BP lowering and evaluates the evidence linking BP control with kidney and cardiovascular (CV) outcomes. RECENT FINDINGS: In 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) began recommending treatment of all individuals to a BP target of < 130/80 mmHg. Since then, multiple post hoc analyses of BP trials have associated intensive BP lowering with acute declines in kidney function and acute kidney injury; whether these represent reversible changes in the kidney is still debated. There is ample evidence that intensive BP lowering is associated with declines in eGFR. The clinical implications of these events remain unclear. Individualizing the risks and benefits of intensive BP therapy continues to be warranted.
PURPOSE OF REVIEW: Acute declines in estimated glomerular filtration rate (eGFR) are often observed during intensive blood pressure (BP) lowering. This review focuses on identifying the various mechanisms of eGFR decline associated with intensive BP lowering and evaluates the evidence linking BP control with kidney and cardiovascular (CV) outcomes. RECENT FINDINGS: In 2017, the American College of Cardiology and the American Heart Association (ACC/AHA) began recommending treatment of all individuals to a BP target of < 130/80 mmHg. Since then, multiple post hoc analyses of BP trials have associated intensive BP lowering with acute declines in kidney function and acute kidney injury; whether these represent reversible changes in the kidney is still debated. There is ample evidence that intensive BP lowering is associated with declines in eGFR. The clinical implications of these events remain unclear. Individualizing the risks and benefits of intensive BP therapy continues to be warranted.
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