Blood pressure target for hypertension in chronic kidney disease: One size does not fit all

Abstract

There is disagreement between the American and the European guidelines for hypertension management in regard to the optimal blood pressure target in patients with chronic kidney disease (CKD). Randomized clinical trials and meta‐analyses of individual patient data pooled from these trials do not clearly support an intensive blood pressure target for the entire population of CKD patients with hypertension. However, some evidence suggests that in CKD patients with proteinuria strict blood pressure control might confer benefit in terms of renal outcome. Tailored treatment strategy based on the individual’s proteinuric profile and tolerability along with standardization of blood pressure measurement methodology including out‐of‐office evaluation are of paramount importance in patients with CKD.

Optimal blood pressure for patients with chronic kidney disease: a nationwide population-based cohort study

“…Hypertension is commonly accompanied by CKD and an important modifiable risk factor for cardiovascular events and CKD progression 3 . Therefore, controlling the blood pressure (BP) within an optimal range is a major public health priority and an important clinical concern for a patient with CKD.Although reports including observational studies, clinical trials, and clinical practice guidelines, attempted to establish an optimal BP target among the CKD patients 4-13 , a definite consensus has not been achieved 14,15 even in more recently released guidelines including the 2017 American Heart Association/American College of Cardiology (AHA/ACC) 12 and the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) 13 guidelines for managing hypertension. The Kidney Disease: Improving Global Outcomes (KDIGO) guideline recommends BP ≤ 140/90 mmHg for CKD patients with urine albumin excretion rate < 30 mg/24 h and ≤ 130/80 mmHg for CKD patients with moderately or severely increased albuminuria 5 .…”

A magas vérnyomás gyógyszeres kezelésének küszöbés célértékei a legjelentősebb terápiás irányelvekben

“…A szerzők részletesen tanulmányozták a kérdést a legújabb elérhető összes -dominánsan a randomizált, kontrollált -tanulmány és elemzés alapján (46)(47)(48)(49), és úgy gondolják, hogy az optimális célérték a szisztolés vérnyomás vonatkozásában 130 Hgmm körüli (minimum 125, maximum 139 Hgmm), a diasztolés esetében 70-79 Hgmm között van, de semmiképpen nem 60 Hgmm alatt. Idős vagy nagyon idős korban (>80 év) a vesefunkció (G-stádiumok), a proteinuria mértéke és az esendőség foka szabja meg a célértéket és -az alapstratégia függvényében -a kezelőorvos egyedi döntése szükséges.…”

Evaluation method of medical service system based on DEMATEL and the information entropy: A case study of hypertension diagnosis and treatment in China

“…Among them, hypertension has the highest incidence in the whole chronic disease system, which seriously affects people's daily life. In addition, this kind of disease has a long course, which requires regular monitoring of disease development and timely intervention to prevent dangerous situations [ 41 – 42 ]. Therefore, how to scientifically and effectively control chronic diseases represented by hypertension has become a key and difficult problem in clinical research.…”

“…has a long course, which requires regular monitoring of disease development and timely intervention to prevent dangerous situations [41][42]. Therefore, how to scientifically and effectively control chronic diseases represented by hypertension has become a key and difficult problem in clinical research.…”