title: Blood pressure management in patients with chronic kidney disease: an appraisal and summary of existing guidelines.
abstract: BACKGROUND
  Hypertension is a prevalent problem with huge impact on health and health care budgets. Several guidelines on how to manage blood pressure have been published, and it is unclear which one should be preferred.
  
  
  METHODS
  Eight guidelines dealing with blood pressure management of chronic kidney disease patients were evaluated for methodological quality by the AGREE II instrument by 4 appraisers. They were also analysed for consistency in their recommendations.
  
  
  RESULTS
  Most problematic domains were "applicability", "stakeholder involvement" and "editorial independence". Three guidelines scored below 50% for 5, and one for 4 of the 6 AGREE II domains. The guideline produced by Canadian Hypertension Education Program was preferred most, followed by KDIGO. There were discrepancies between the different guidelines with regard to blood pressure targets and thresholds, with the best and most recent advocating 140/90 mmHg. There was a consensus on the use of ACE-I/ARB's in patients with but not for those without proteinuria. However, only two guidelines specify a second line treatment (thiazides), whereas others do not, although it is well known that most patients need more than one drug to control their blood pressure. Three out of eight guidelines did not provide guidance on life-style modification. Those who did, advocated different levels of sodium restriction,, weight control, and physical activity. Remarkably, 5 out of 8 guidelines did not specify how exactly blood pressure should be measured.
  
  
  CONCLUSIONS
  Blood pressure guidelines seem to be of low methodological quality, with clear improvements for the ones produced the latest. Especially the "applicability" domain, evaluating how the guideline can be put into practice, seems problematic, with as biggest hurdles that it is unclear what should be second or third line treatments, and how blood pressure should be measured or defined. The most recent guidelines advocate an office blood pressure of 140/90 mmHg for patients with chronic kidney disease.
authors.forename: W
authors.initials: W
authors.lastname: Van Biesen
authors.forename: T
authors.initials: T
authors.lastname: Van de Velde
authors.forename: M
authors.initials: M
authors.lastname: Slabbaert
authors.forename: I
authors.initials: I
authors.lastname: Simoens
authors.forename: R
authors.initials: R
authors.lastname: Van Paemel
authors.forename: Sn
authors.initials: S
authors.lastname: van der Veer
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D004039:Diet, Sodium-Restricted / Q000379:methods; D017408:Guidelines as Topic; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000628:therapy*; D008019:Life Style; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy*
chemical_list: D000959:Antihypertensive Agents
keywords: AGREE II tool; chronic kidney disease,; guideline,; hypertension,