Hypertension in chronic kidney disease (CKD): diagnosis, classification and therapeutic targets

Link to article at PubMed

Am J Hypertens. 2020 Dec 17:hpaa209. doi: 10.1093/ajh/hpaa209. Online ahead of print.


Blood pressure (BP) in the office is often recorded without standardization of the technique of measurement. When office BP measurement is performed with a research-grade methodology, it can inform better therapeutic decisions. The reference-standard method of ambulatory BP monitoring together with the assessment of BP in the office enables the identification of white-coat and masked hypertension, facilitating the stratification of cardiorenal risk. Compared with general population, the prevalence of resistant hypertension is 2- to 3-fold higher among patients with chronic kidney disease (CKD). The use of ambulatory BP monitoring is mandatory in order to exclude the white-coat effect, a common cause of pseudoresistance, and confirm the diagnosis of true-resistant hypertension. After the premature termination of SPRINT due to an impressive cardioprotective benefit of intensive BP-lowering, the 2017 AHA/ACC guideline reappraised the definition of hypertension and recommended a tighter BP target of <130/80 mmHg for the majority of adults with a high cardiovascular risk profile, inclusive of patients with CKD. However, the benefit/risk ratio of intensive BP-lowering in particular subsets of patients with CKD (i.e. those with diabetes or more advanced CKD) continues to be debated. We explore the controversial issue of BP targets in CKD, providing a critical evaluation of the available clinical-trial evidence and guideline recommendations. We argue that the systolic BP target in CKD, if BP is measured correctly, should be <120 mmHg.

PMID:33331853 | DOI:10.1093/ajh/hpaa209

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