I attended a very interesting talk from Dr Bakris today on the latest approaches to BP targets in the CKD population. The highlights are nicely illustrated in a systematic review published in the Annals this year.
They searched for randomized controlled trials comparing blood pressure targets in adults with CKD that had more than 50 participants per group; at least 1-year follow-up; with death, kidney failure, cardiovascular events, change in kidney function, number of antihypertensive agents and adverse events as the outcomes of interest. There were three trials that met these criteria, with a total of 2272 subjects contributing data.
Interestingly they found that there was no evidence to suggest that a target of less than 125/75 to 130/80 mm Hg was more beneficial than targets less than 140/90 mmHg.
However, the degree of proteinuria may be an effect modifier here – in this regard they found lower quality evidence to suggest that in those with macroalbuminuria (0.3 – 1.0g/day), the lower target may be beneficial.
The main limitation of this review was that the trials involved were limited to non-diabetic CKD patients.
The tide of opinion may be turning in relation to BP guidelines, so watch closely for any announcements from the major societies in relation to this. It’s important to avoid complacency though, and a relaxation of the target shouldn’t mean we place less emphasis on BP control.