title: Is the lower blood pressure target for patients with chronic kidney disease supported by evidence?
abstract: OBJECTIVE
  Major guidelines recommend a blood pressure (BP) target of less than 130/80  mmHg for patients with chronic kidney disease (CKD) even though the optimal BP target in this population is unclear. This review summarizes the evidence on BP target in CKD and highlights recent pertinent publications.
  
  
  RESULTS
  Clinical trials in CKD have not definitively shown that setting a BP target that is lower than the standard target of less than 140/90  mmHg provides additional benefit for important clinical outcomes. However, subgroup analyses from the recently published posttrial cohort of the African-American Study of kidney disease and a systematic review of BP target trials in CKD suggest that lower than the standard BP target may be beneficial in patients with proteinuria level of more than 300 or 1000  mg/day.
  
  
  CONCLUSIONS
  Evidence supports a BP target of less than 140/90  mmHg in most patients with CKD. A lower target may be chosen in CKD patients with proteinuria after individualized risk-benefit assessment. Treatment to a lower target may require greater vigilance to monitor for and avoid possible symptoms and adverse events from hypotension.
authors.affiliation: Renal Section, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Upadhyay
authors.forename: Katrin
authors.initials: K
authors.lastname: Uhlig
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001794:Blood Pressure; D019317:Evidence-Based Medicine; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy*; D007676:Kidney Failure, Chronic / Q000188:drug therapy* / Q000209:etiology; D011507:Proteinuria / Q000188:drug therapy* / Q000209:etiology
chemical_list: D000959:Antihypertensive Agents