Blood Pressure targets in Chronic Kidney Disease: still no consensus

Lucas, Bethany; Taal, Maarten W

Abstract

Purpose of review
Despite a strong consensus that treatment of hypertension is fundamental to strategies seeking to slow chronic kidney disease (CKD) progression and reduce the associated risk of cardiovascular events (CVE), controversy persists regarding optimal blood pressure (BP) targets. This article reviews the evidence for different targets, discusses associated controversies and suggests approaches to improve BP control.

Recent findings
Landmark clinical trials established the principle that lower BP targets are associated with slower progression of CKD in people with a greater magnitude of proteinuria and previous guidelines recommended a target BP of <130/80 mmHg for those with proteinuria. However, the Systolic Blood Pressure Intervention Trial provided new evidence that a systolic BP target of <120 mmHg was associated with a reduced risk of CVE, though there was no impact on CKD progression and there was concern about an increase in renal adverse events. Nevertheless, 2021 Kidney Disease Improving Global Outcomes guidelines recommended systolic BP <120 mmHg, though other updated guidelines did not follow this trend. All guidelines emphasise the importance of standardised BP measurement and a personalised approach.

Summary
An individualised and shared decision-making approach to BP target setting and management is recommended, guided by standardised BP measurement.

• Journal Article Type: Article
• Acceptance Date: Aug 8, 2023
• Online Publication Date: Sep 30, 2023
• Publication Date: 2023-11
• Deposit Date: Aug 10, 2023
• Publicly Available Date: Oct 1, 2024
• Journal: Current Opinion in Nephrology and Hypertension
• Print ISSN: 1062-4821
• Electronic ISSN: 1473-6543
• Publisher: Lippincott, Williams & Wilkins
• Peer Reviewed: Peer Reviewed
• Volume: 32
• Issue: 6
• Pages: 497-501
• DOI: https://doi.org/10.1097/MNH.0000000000000920
• Keywords: Blood pressure, chronic kidney disease, guidelines, hypertension, measurement
• Public URL: https://nottingham-repository.worktribe.com/output/24144516
• Publisher URL: https://journals.lww.com/co-nephrolhypertens/abstract/2023/11000/blood_pressure_targets_in_chronic_kidney_disease_.2.aspx