Purpose of review
Hypertension is a major risk factor for cardiovascular disease, cerebrovascular events, and progression to end-stage kidney disease (ESKD). The kidneys play a causative role in hypertension, but they are also organs vulnerable to hypertensive injury. Thus far, goals for optimal blood pressure in chronic kidney disease (CKD) and ESKD patients are not fully elucidated. Herein, we critically review the existing evidence.
Large randomized controlled trials (RCTs) continue to be deemed as the best source of evidence to guide optimal blood pressure goals in CKD and ESKD patients. Despite recent advances, the growing body of literature does not permit drawing definitive conclusions. Few adequately powered RCTs have specifically assessed goals for treatment of hypertension in patients with CKD. The most recent large RCT in hypertension, the Systolic Blood Pressure Intervention Trial, included a subset of patients with CKD and provided some insights. For the ESKD population, trials to evaluate blood pressure goals are even more scarce. The Blood Pressure in Dialysis Trial was a relatively small pilot study that can be deemed as hypothesis generating.
Management of hypertension in CKD is essential for optimization of cardiovascular, cerebrovascular and renal outcomes. To date, the existing evidence does not fully clarify ideal targets for blood pressure control in this patient population.