BP goal for the treatment of hypertension in CKD
What should be the goal blood pressure for the treatment of hypertension in patients with CKD?
Long-term follow-up of participants with nondiabetic CKD in the Modification of Diet in Renal Disease study showed that aggressive control of blood pressure was associated with slowing in the rate of loss of kidney function.
However, the results of other studies examining the association of intensity of blood pressure control on the progression of kidney disease has not been consistent, and a recent meta-analyses of clinical trials in patients with nondiabetic kidney disease was not able to show the benefit as seen in the Modification of Diet in Renal Disease study.
The results of the Systolic Blood Pressure Intervention Trial (SPRINT) trial have recently been published and show that targeting blood pressure <120 mm Hg systolic, measured using a standardized approach distinct from how measurements are made in clinical practice, was associated with a 25% lower risk for the composite primary outcome of myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes.
The benefit was the same in patients with and without kidney disease; the results of the effect of aggressive control of blood pressure on the rate of loss of kidney function are awaited.
Given the results of this landmark study, it seems prudent to target lower blood pressure in patients with CKD, which has not been the norm recently.
