Blood Pressure Targets in Chronic Kidney Disease: An Update on the Evidence

Dominique Guerrot; Jelmer K. Humalda

Disclosures

Curr Opin Nephrol Hypertens. 2020;29(3):327-332. 

In This Article

Abstract and Introduction

Abstract

Purpose of review: Hypertension is the leading modifiable cause of cardiovascular events and of mortality and is generally considered as a direct cause of chronic kidney disease. Defining optimal blood pressure targets in patients with chronic kidney disease is therefore of critical importance.

Recent findings: Over the recent years, results and post-hoc analyses of several important trials comparing blood pressure targets which included patients with chronic kidney disease have been published. Although these results provide important means to understand the consequences of high blood pressure and to improve the management of hypertension in chronic kidney disease, they led to remarkably different interpretations and recommendations in the current guidelines.

Summary: The present review summarizes the current evidence and areas of controversy for the definition of blood pressure targets in patients with chronic kidney disease.

Introduction

Hypertension is the leading modifiable risk factor for mortality in developed countries.[1] In patients with chronic kidney disease (CKD), the prevalence of hypertension increases with the progression of kidney disease and is close to 90% in stage 5 CKD.[2,3] Hypertension contributes significantly to the excess cardiovascular mortality of the CKD population and its management is an everyday concern for the nephrologist. Although there is a clear epidemiological link between blood pressure (BP) level and cardiovascular morbidity and mortality,[4] the BP target under treatment in hypertensive patients, including in CKD patients, remains highly debated. The present review aims to synthesize current evidence on BP control in patients with nondialysis nontransplanted CKD, by integrating the results of the major randomized controlled trials (RCT) and meta-analyses recently published.

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