Tight Blood Pressure Control in Chronic Kidney Disease

Abstract

Hypertension affects over a billion people worldwide and is the leading cause of cardiovascular disease and premature death worldwide, as well as one of the key determinants of chronic kidney disease worldwide. People with chronic kidney disease and hypertension are at very high risk of renal outcomes, including progression to end-stage renal disease, and, even more importantly, cardiovascular outcomes. Hence, blood pressure control is crucial in reducing the human and socio-economic burden of renal and cardiovascular outcomes in those patients. However, current guidelines from hypertension and renal societies have issued different and sometimes conflicting recommendations, which risk confusing clinicians and potentially contributing to a less effective prevention of renal and cardiovascular outcomes. In this review, we critically appraise existing evidence and key international guidelines, and we finally formulate our own opinion that clinicians should aim for a blood pressure target lower than 130/80 in all patients with chronic kidney disease and hypertension, unless they are frail or with multiple comorbidities. We also advocate for an even more ambitious systolic blood pressure target lower than 120 mmHg in younger patients with a lower burden of comorbidities, to minimise their risk of renal and cardiovascular events during their lifetime.

New Perspectives and Strategies for the Management of Hypertension

“…Finally, five review articles are included in this Special Issue. They discuss the role of artificial intelligence [ 16 ], the prognostic value of a tight BP control in chronic kidney disease [ 17 ], implications of endothelial dysfunction as therapeutic target [ 18 ] in hypertension and other conditions [ 19 ], the link between hypertension and cardiac arrhythmias [ 20 , 21 ], and recent advances in the management of hypertensive patients with a potential clinical role in the years to come (including renal denervation) [ 22 ].…”