Blood Pressure Control, Proteinuria, and the Progression of Renal Disease

Jc, Peterson; Adler, Sharon G.; Jm, Burkart; Greene, Tom; La, Hank; Lg, Hunsicker; Aj, King; Klahr, Saulo; Sg, Massry; Jl, Seifter

doi:10.7326/0003-4819-123-10-199511150-00003

Cited by 1,220 publications

(759 citation statements)

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“…As for the optimal blood pressure (BP) in CKD patients, the recommended target systolic BP (SBP)/diastolic BP (DBP) is \140/90 mmHg for those without albuminuria and \130/80 mmHg for those with urine albumin excretion rates [30 mg/24 h, according to the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines [3]. The recommendations were derived from previous data such as those from the MDRD (Modification of Diet in Renal Disease) study and the AASK (AfricanAmerican Study of Kidney Disease and Hypertension), which demonstrated that aggressive BP control to lower BP targets was associated with a lower risk of CKD progression, especially in patients with proteinuria [4,5]. However, the lower limit of the optimal BP target range for patients with CKD remains unclear.…”

Section: Introductionmentioning

confidence: 99%

Relationship between low blood pressure and renal/cardiovascular outcomes in Japanese patients with chronic kidney disease under nephrologist care: the Gonryo study

et al. 2015

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Background Previous studies established a J-shaped association between blood pressure (BP) and cardiovascular disease (CVD) in chronic kidney disease (CKD), and the different clinical profiles of CVD by ethnicity. However, the adequately lower BP target remains unclear in Asian patients with CKD. Methods This prospective observational study included 2,655 Japanese outpatients with CKD under nephrologist care who met the inclusion criteria, namely estimated glomerular filtration rate \60 mL/min and/or presenting proteinuria. The patients were divided by 10-mmHg BP increments by clinical data. The end points were death, cardiovascular events (CVEs), and end-stage kidney disease (ESKD) that requires renal replacement therapy. Results During a 3.02-year median follow-up, 64 patients died, 120 developed CVEs, and 225 progressed to ESKD. In the adjusted Cox models, the risks of CVEs and allcause mortality were higher in the patients with systolic BPs (SBPs) \ 110 mmHg than in those with SBPs of 130-139 mmHg. Moreover, the risk was higher in those with diastolic BPs (DBPs) \ 70 mmHg than in those with DBPs of 80-89 mmHg. Although SBPs C 140 mmHg were associated with higher incidence rates of ESKD, no significant increased risk was associated with BPs \ 130/ 80 mmHg. Conclusions SBPs \ 110 mmHg and DBPs \ 70 mmHg were independent risk factors of CVEs and all-cause mortality. No lower BPs were observed as significant risk factors of progression to ESKD. This study suggests that the lower BP target in Asian patients with CKD should be C110/70 mmHg.

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Section: Introductionmentioning

confidence: 99%

Relationship between low blood pressure and renal/cardiovascular outcomes in Japanese patients with chronic kidney disease under nephrologist care: the Gonryo study

et al. 2015

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“…Blood pressure (BP) level is widely recognized to strongly correlate with CKD, as it does with other cardiovascular diseases. [3][4][5] Clinical guidelines recommend using mean BP, systolic BP (SBP) and diastolic BP (DBP) for diagnosis and management of hypertension to prevent cardiovascular events such as progression of renal dysfunction.…”

Section: Introductionmentioning

confidence: 99%

The impact of visit-to-visit variability in blood pressure on renal function

et al. 2011

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Hypertension is an important risk factor for cardiovascular diseases such as chronic kidney disease. It is still not fully understood how blood pressure impacts the kidneys. In this study, we aimed to establish the significance of visit-to-visit variability in blood pressure for renal function. We analyzed 143 consecutive patients undergoing renal Doppler ultrasonography in our hospital ward and measured blood pressure at outpatient visits six or more times. We analyzed the correlation between visit-to-visit variability in blood pressure and multiple clinical parameters, including albuminuria and resistive index evaluated by renal Doppler ultrasonography, which is thought to be a good indicator of renal vascular resistance. Subjects with higher variability in systolic blood pressure showed a significantly higher prevalence rate of clinical albuminuria and microalbuminuria, and showed significantly higher resistive index. Stepwise multiple regression analysis showed that variability in systolic blood pressure was a significant risk factor for higher resistive index, independent of other renal risk factors. Visit-to-visit variability in blood pressure correlates significantly with renal function and renal arteriosclerotic change. This parameter could provide additional information about renal arteriosclerotic change independent of estimated glomerular filtration rate and albuminuria, and should be considered a therapeutic target for renal protection.

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“…Nor should they diminish our enthusiasm for controlling hypertension in patients with primary renal disease, particularly those with proteinuria, where hypertension control has clearly been shown to attenuate the rate of progression to end-stage renal disease. 54, 55 The results of this metaanalysis however should encourage rethinking of whether non-malignant hypertension by itself is an important cause of renal dysfunction since the current best available data from randomised clinical trials fail to show that antihypertensive drug therapy reduces the incidence of renal dysfunction in patients with non-malignant hypertension.…”

Section: Discussionmentioning

confidence: 99%

Does treatment of non-malignant hypertension reduce the incidence of renal dysfunction? A meta-analysis of 10 randomised, controlled trials

Hsu

2001

J Hum Hypertens

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Objective: It remains controversial whether non-malignant 'benign' hypertension causes renal dysfunction. The effect of lowering blood pressure on the incidence of renal dysfunction among patients with non-malignant hypertension is not clear. This meta-analysis was conducted to determine whether antihypertensive drug therapy reduces the incidence of renal dysfunction in patients with non-malignant hypertension. Methods: Randomised, controlled trials of antihypertensive drug therapy of more than 1 year duration that reported renal dysfunction as an outcome were identified through MEDLINE search and literature review. A random effects model was used to obtain summary estimates. Results: Ten trials were identified, involving 26 521 individuals and 114 000 person-years. All excluded subjects with advanced baseline renal disease. Definition of renal

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Blood Pressure Control, Proteinuria, and the Progression of Renal Disease

Cited by 1,220 publications

References 0 publications

Relationship between low blood pressure and renal/cardiovascular outcomes in Japanese patients with chronic kidney disease under nephrologist care: the Gonryo study

Relationship between low blood pressure and renal/cardiovascular outcomes in Japanese patients with chronic kidney disease under nephrologist care: the Gonryo study

The impact of visit-to-visit variability in blood pressure on renal function

Does treatment of non-malignant hypertension reduce the incidence of renal dysfunction? A meta-analysis of 10 randomised, controlled trials

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