What are the blood pressure targets for patients with chronic kidney disease?

Česká verzia

Authors: Ivan Rychlík; Petra Bachroňová; Anna Maršáková; Lidmila Francová; Karolína Krátká
Authors place of work: I. interní klinika 3. LF UK a FN Královské Vinohrady Praha
Published in the journal: Vnitř Lék 2020; 66(3): 200-204
Category:

Summary

Cardiovascular (CV) diseases remain the main reason for mortality and morbidity among patients with or without chronic kidney disease (CKD) and hypertension represents one of their risk factor. Despite the lack of definitive evidence that intensive blood pressure (BP) lowering improves kidney function outcomes, we agree with the recommendation of target BP < 130/80 mm Hg in most adults with CKD for the purpose of CV disease prevention. SPRINT trial showed that more intensive systolic BP control decreased the incidence of CV events and death, including in patients with CKD. On the other hand, intensive BP control may lead to a slightly faster decline in eGFR and increased AKI (acute kidney injury) incidence. These adverse events (AE) are usually reversible, of low absolute magnitude, but of unclear clinical relevance, and, furthermore, with certain impact of economy in AE treatment. Patients with chronic heart failure, with advance CKD and seniors generally belong to the most risky groups. Thus, we can conclude, the benefit of intensive BP control will, in most circumstances, outweigh kidney and other adverse outcomes, but the intensity of BP control and BP targets should be individualised and should respect specific risk/benefit ratio of each single patient.

Keywords:

blood pressure – hypertension – chronic kidney disease

Zdroje

1. Xie X, Atkins E, Lv J, et al. Effects of intensive blood pressure lowering on cardiovascular and renal outcomes: Updated systematic review and meta‑analysis. Lancet 2016; 387: 435–443.

2. Upadhyay A, Earley A, Haynes SM, et al. Systematic review: Blood pressure target in chronic kidney disease and proteinuria as an effect modifier. Ann Intern Med 2011; 154: 541–548.

3. Lazich I, Bakris GL Prediction and management of hyperkalemia across the spectrum of chronic kidney disease. Semin Nephrol 2014; 34: 333–339.

4. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/ APhA/ASH/ ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018; 71: e127–e248.

5. Wright jr. JT, Williamson JD, Whelton PK, et al. SPRINT Research Group: A randomized trial of intensive versus standard blood‑pressure control. N Engl J Med 2015; 373: 2103–2116.

6. Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004; 351: 1296–1305.

7. Chobanian AV, Bakris GL, Black HR, et al. Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. National Heart, Lung, and Blood Institute; National High Blood Pressure Education Program Coordinating Committee: Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003; 42: 1206–1252.

8. Weiss JW, Peters D, Yang X, et al. Systolic BP and mortality in older adults with CKD. Clin J Am Soc Nephrol 2015; 10: 1553–1559.

9. Kovesdy CP, Alrifai A, Gosmanova EO, et al. Age and outcomes associated with BP in patients with incident CKD. Clin J Am Soc Nephrol 2016; 11: 821–831.

10. Klahr S, Levey AS, Beck GJ, e al. Modification of Diet in Renal Disease Study Group: The effects of dietary protein restriction and blood‑pressure control on the progression of chronic renal disease. N Engl J Med 1994; 330: 877–884.

11. Wright jr. JT, Bakris G, Greene T, et al. Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: Results from the AASK trial. JAMA 2002; 288: 2421–2431.

12. Cushman WC, Evans GW, Byington RP, et al. ACCORD Study Group: Effects of intensive blood‑pressure control in type 2 diabetes mellitus. N Engl J Med 2010; 362: 1575–1585.

13. James PA, Oparil S, Carter BL, et al. 2014 evidence‑based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014; 311: 507–520.

14. Cheung AK, Rahman M, Reboussin DM, et al. Effects of intensive BP control in CKD. J Am Soc Nephrol 2017; 28: 2812–2823.

15. Perkovic V, Rodgers A. Redefining blood‑pressure targets–SPRINT starts the marathon. N Engl J Med 2015; 373: 2175–2178.

16. Beddhu S, Rocco MV, Toto R, et al. SPRINT Research Group: Effects of intensive systolic blood pressure control on kidney and cardiovascular outcomes in persons without kidney disease: A secondary analysis of a randomized trial. Ann Intern Med 2017; 167: 375–383.

17. Palmer BF Renal dysfunction complicating the treatment of hypertension. N Engl J Med 2002; 347: 1256–1261.

18. Sarnak MJ, Greene T, Wang X, et al. The effect of a lower target blood pressure on the progression of kidney disease: Long‑term follow‑up of the modification of diet in renal disease study. Ann Intern Med 2005; 142: 342–351.

19. Appel LJ, Wright jr. JT, Greene T, et al. AASK Collaborative Research Group: Intensive blood‑pressure control in hypertensive chronic kidney disease. N Engl J Med 2010; 363: 918–929.

20. Lv J, Ehteshami P, Sarnak MJ, et al. Effects of intensive blood pressure lowering on the progression of chronic kidney disease: A systematic review and meta‑analysis. CMAJ 2013; 185: 949–957.

21. Ku E, Bakris G, Johansen KL, et al. Acute declines in renal function during intensive BP lowering: Implications for future ESRD risk. J Am Soc Nephrol 2017; 28: 2794–2801.

22. Adams PL, Adams FF, Bell PD, et al. Impaired renal blood flow autoregulation in ischemic acute renal failure. Kidney Int 1980; 18: 68–76.

23. Rocco MV, Sink KM, Lovato LC, et al. SPRINT Research Group: Effects of intensive blo‑ od pressure treatment on acute kidney injury events in the systolic blood pressure intervention trial (SPRINT). Am J Kidney Dis 2018; 71: 352–361.

24. Ku E, Bakris G, Johansen KL, et al. Acute declines in renal function during intensive BP lowering: Implications for future ESRD risk. J Am Soc Nephrol 2017; 28: 2794–2801.

25. Hala Yamout H, Bakris GL. Consequences of Overinterpreting Serum Creatinine Increases when Achieving BP Reduction. Balancing Risks and Benefits of BP Reduction in Hypertension. Clin J Am Soc Nephrol 2018; 13: 9–10.

26. Malhotra R, Nguyen HA, Benavente O, et al. Association between more intensive vs less intensive blood pressure lowering and risk of mortality in chronic kidney disease stages 3 to 5: A systematic review and meta‑analysis. JAMA Intern Med 2017; 177: 1498–1505.

27. Chang TI, Sarnak MJ. Intensive blood pressure targets and kidney diseases. Clin J Am Soc Nephrol 2018; 13: 1575–1577.

28. Stephen C, Textor SC, Schwartz GL. BP Targets in CKD, Mortality, and SPRINT: What Have We Learned? J Am Soc Nephrol 2017; 28: 2561–2563.

29. Tozawa M, Iseki K, Iseki C, et al. Blood pressure predicts risk of developing end‑stage renal disease in men and women. Hypertension 2003; 41: 1341–1345.

30. Magrico R, Bigotte Vieira MB, Viegas Dias CV, et al. BP Reduction, Kidney Function Decline, and Cardiovascular Events in Patients without CKD. Clin J Am Soc Nephrol 2018; 13: 73–80.