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

Dominique Guerrot; Jelmer K. Humalda


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

In This Article

What do the Guidelines Recommend?

The three major guidelines currently defining BP targets in CKD are summarized in Figure 2.

Figure 2.

Blood pressure (BP) targets in patients with chronic kidney disease (CKD) recommended by the latest KDIGO, ACC/AHA, and ESH/ESC guidelines (31, 41, 42). Exceptions defined by ESH/ESC for age more than 80 and diabetes mellitus are not included in the figure.

In 2017, a KDIGO conference was dedicated to reexamine the 2012 KDIGO guideline by including data from the most recent trials published, including SPRINT and SPS3. The summary of this conference, published in 2019, suggested BP targets in CKD should be revised, but underline the numerous areas of uncertainty in defining these targets, especially regarding applicability of the results of SPRINT to CKD patients with significant albuminuria, eGFR less than 45 ml/min and diabetes mellitus.[41]

Although the most recent guidelines (ACC/AHA 2017 and ESH/ESC 2018) rely on the same evidence it is remarkable that they generated significantly different conclusions, both in the general and the CKD population.[42,43] This situation, which mainly stems from different definitions of hypertension, identification of subpopulations, and implementation of methodological issues of the SPRINT study in clinical practice, is dramatically confusing for clinicians.