Blood Pressure & End-Stage Renal Disease in Patients With CKD

Studies have shown that treating high blood pressure (BP) is one of the most important strategies to slowing the progression from chronic kidney disease (CKD) to end-stage renal disease (ESRD). Currently, a BP goal of less than 130/80 mm Hg is recommended for patients with CKD, a target lower than the goal recommended for people without CKD (less than 140/90 mm Hg). Despite the dissemination of clinical guidelines, meeting BP targets in people with CKD may be difficult in clinical practice. “The most recent evidence supporting the use of lower BP targets in people with CKD has been conflicting,” explains Carmen A. Peralta, MD, MAS. “The association of BP levels and ESRD risk in a large, national, community-based setting of persons with established CKD has not been well studied. In addition, some recent reports have found that higher pulse pressure and lower diastolic BP (DBP) may lead to adverse cardiovascular outcomes. This can make it especially challenging for clinicians to control BP aggressively in patients with CKD.” Associations Between BP and ESRD Few studies have investigated the association of each BP component with ESRD risk. In Archives of Internal Medicine, Dr. Peralta and colleagues had a study published that investigated the independent association of systolic BP (SBP) and DBP with ESRD risk in patients with CKD who participated in the Kidney Early Evaluation Program (KEEP), a nationwide kidney health screening program offered by the National Kidney Foundation. More than 16,000 patients in KEEP were studied in the analysis, all of whom had at least stage III CKD. “In the past, questions have been raised about the established BP targets...