Current Cardiology Reports

, 13:492

What is the Ideal Blood Pressure Goal for Patients with Stage III or Higher Chronic Kidney Disease?

  • Yazan Khouri
  • Susan P. Steigerwalt
  • Mershed Alsamara
  • Peter A. McCullough
Hypertension (Matthew Sorrentino, Section Editor)

DOI: 10.1007/s11886-011-0215-0

Cite this article as:
Khouri, Y., Steigerwalt, S.P., Alsamara, M. et al. Curr Cardiol Rep (2011) 13: 492. doi:10.1007/s11886-011-0215-0

Abstract

Hypertension and chronic kidney disease (CKD) are public health problems well known to the national and international medical communities. Blood pressure (BP) control in patients with CKD stage III and IV plays a key factor in reducing cardiovascular risk and renal disease progression. We conducted a literature review of recent studies addressing BP targets and cardiorenal outcomes in patients with CKD. Multiple studies demonstrated cardiovascular benefits associated with greater BP reduction. Nevertheless, a U-shaped relationship between BP, cardiovascular events, and renal function was present. In patients with CKD stage III and IV, a BP less than 140/90 mm Hg appeared to be a reasonable target. Moreover, in patients with CKD and proteinuria of more than 1 g/day, a target systolic BP of 120 to 130 mm Hg and diastolic BP of 70 to 80 mm Hg yielded the greatest benefit while avoiding most of the adverse cardiovascular outcomes associated with lower levels of BP.

Keywords

Chronic kidney diseaseHypertensionCardiovascular eventsStrokeRenal functionBlood pressure targets

Clinical Trial Acronyms

AASK

African American Study of Kidney Disease and Hypertension

ACCORD

Action to Control Cardiovascular Risk in Diabetes

ADVANCE

Action in Diabetes and Vascular disease: Preterax and Diamicron-MR Controlled Evaluation

CAFE

Conduit Artery Function Evaluation

HOPE

Heart Outcomes Prevention Evaluation

HOT

Hypertension Optimal Treatment

INVEST

International Verapamil-Trandolapril Study

MDRD

Modification of Diet in Renal Disease

NHANES

National Health and Nutrition Examination Survey

ONTARGET

Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial

PROGRESS

Perindopril Protection Against Recurrent Stroke Study

PROVE IT-TIMI 22

Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22

REIN

Ramipril Efficacy in Nephropathy

VALUE

Valsartan Antihypertensive Long-term Use Evaluation.

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Yazan Khouri
    • 1
    • 2
  • Susan P. Steigerwalt
    • 1
  • Mershed Alsamara
    • 1
  • Peter A. McCullough
    • 1
  1. 1.St. John Providence Health System, Providence Hospital and Medical Center, High-Risk Hypertension ProgramProvidence Heart InstituteSouthfieldUSA
  2. 2.Department of MedicineProvidence HospitalSouthfieldUSA