Chronic Kidney Disease and Hypertension

A Destructive Combination

Leticia Buffet, PharmD; Charlotte Ricchetti, PharmD, BCPS, CDE

Disclosures

US Pharmacist 

In This Article

Goals of Therapy

Patients with nondiabetic and diabetic CKD should have a target BP goal of <130/80 mmHg.[8–10] Ultimately, the rationale for lowering BP in all patients with CKD is to reduce both renal and cardiovascular morbidity and mortality. Maintaining BP control and minimizing proteinuria in patients with CKD and HTN is essential for the prevention of the progression of kidney disease and the development or worsening of CVD.[8,9]

Recent literature suggests that BP targets in diabetic and nondiabetic CKD may need to be individualized based on the presence of proteinuria. Some trials have failed to show a reduction in cardiovascular or renal outcomes in diabetic and nondiabetic patients with CKD when a BP target of <130/80 mmHg is achieved compared to lowering BP to <140/90 mmHg.[15,16] However, patients who have proteinuria are less likely to experience a decline in renal function, kidney failure, or death when the lower BP target is achieved.[15,17] It is likely that future guidelines may include a lower BP goal, <130/80 mmHg, for patients with proteinuria, but maintain a goal of <140/90 mmHg for patients without proteinuria.

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