Intensive blood pressure lowering in chronic kidney disease: the time has come.

Abstract

Release of the findings from the Systolic Blood Pressure Intervention Trial has resulted in a renewed examination of intensive blood pressure (BP) lowering. Only a few national hypertension guidelines (Canada and Australia) have changed recommendations, but considerable heterogeneity still exists with respect to the patient population to whom intensive BP lowering may apply. There is fairly robust evidence that lower BP targets in nondiabetic chronic kidney disease (CKD) results in a decrease in heart failure and mortality. Similar data exist in patients with diabetes and CKD for reduction in stroke. Consideration of the differences in BP measurement methods in newer trials helps us understand and interpret the findings. Though often times less is more with respect to therapeutic measures, in patients with CKD, more BP lowering will result in more cardiovascular benefit. Use of newer oscillometric BP devices with adequate resting prior and judicious patient selection are the key aspects to be considered when applying intensive BP lowering.