2011 Top Game Changers in Nephrology

George Bakris, MD; Jeffrey S. Berns, MD; Lynda A. Szczech, MD; Carol Peckham

Disclosures

November 16, 2011

In This Article

6. Blood Pressure Goals: Is 140 Good Enough for Everyone?

According to a review from Katrin Uhlig and colleagues,[6] published in April 2011 in the Annals of Internal Medicine, CKD patients had no improvements in measured outcomes -- including kidney failure, cardiovascular events, and death -- when managed with a blood pressure target of < 130/80 mm Hg, rather than the normal target of < 140/90 mm Hg. The only significant exception was in the Modification of Diet in Renal Disease (MDRD) study, in which patients in a low target arm had a 23% reduction in hazard for kidney failure at a follow-up of about 6 years. The review included 3 trials and a total of 2272 patients with CKD. The studies also included subgroups of patients with proteinuria, but all excluded patients with actively managed diabetes. George Bakris, in a Skype discussion with Rajiv Agarwal, said, "There's been a groundswell of evidence that less than 140 mm Hg is perfectly appropriate. We do not need to go to less than 130 mm Hg, even in diabetes. Certainly the National Institute for Health and Clinical Excellence (NICE) guidelines have this information in their recent update and JNC 8 is certainly going to talk about this as well."[7]He continued, " There's one exception to the < 140/90 mm Hg, and that is people with proteinuria, usually with chronic kidney disease and, specifically, proteinuria at levels well above 300 mg/L a day and certainly up to 500 mg/L and higher. In that circumstance the data are pretty clear that less than 130 mm Hg still is the goal and still should be there."

Review the complete discussion between Drs. Bakris and Agarwal.

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