title: The lingering dilemma of arterial pressure in CKD: what do we know, where do we go?
abstract: Despite many advances in the management of hypertensive chronic kidney disease (CKD) patients, both on and off dialysis, there exist several gaps in our knowledge. Although the modern techniques to measure blood pressure (BP) indirectly have been available for a long time, among those with CKD, how to best assess hypertension and the level to which it should be lowered are mired in controversy. Other controversial areas relate to a lack of a consensus definition of hypertension among hemodialysis patients, uncertainty in the definition and assessment of volume excess, and the lack of adequately powered randomized trials to evaluate the level to which BP can be lowered in those on dialysis. This review discusses the limitations of the available evidence base and suggests areas for future research. Suggestions include evaluation of techniques to assess volume, randomized trials to target different levels of BP among hypertensive hemodialysis patients, evaluation of ambulatory BP monitoring, and non-pharmacological means to lower BP in CKD. It is hoped that among patients with CKD these data will improve the dismal cardiovascular outcomes.
authors.affiliation: Indiana University and VAMC , Indianapolis, Indiana, USA.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Agarwal
authors.affiliation: Hospital Universitario de Bellvitge, IDIBELL, L'Hospitalet de Llobregat , Barcelona, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Martinez-Castelao
authors.affiliation: Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia , Katowice, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Wiecek
authors.affiliation: INSERM ERI-12 (EA 4292) , Amiens, France ; Amiens University Hospital and the Jules Verne University of Picardie , Amiens, France.
authors.forename: Ziad
authors.initials: Z
authors.lastname: Massy
authors.affiliation: Nephrology Division, Department of Medicine, Akdeniz University Medical School , Antalya, Turkey.
authors.forename: Gultekin
authors.initials: G
authors.lastname: Suleymanlar
authors.affiliation: IIS-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo , Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Ortiz
authors.affiliation: Department of Nephrology, University Medical Center , Utrecht, The Netherlands.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.affiliation: Clinic of Nephrology, C.I. Parhon University Hospital, Gr. T. Popa University of Medicine and Pharmacy , Iasi, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center , Leiden, The Netherlands.
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
authors.affiliation: ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam , Amsterdam, The Netherlands.
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet , Stockholm, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Lindholm
authors.affiliation: Renal Unit, Guy's and St Thomas' NHS Foundation Hospital, King's Health Partners , London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Goldsmith
authors.affiliation: Department of Internal Medicine IV, Saarland University Medical Centre , Homburg/Saar, Germany.
authors.forename: Danilo
authors.initials: D
authors.lastname: Fliser
authors.affiliation: INSERM U970, Hôpital Européen Georges Pompidou , Paris, France.
authors.forename: Gerard
authors.initials: G
authors.lastname: London
authors.affiliation: Nephrology, Dialysis and Transplantation Unit and CNR-IBIM Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension , Reggio Calabria, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Zoccali
keywords: CKD; ambulatory blood pressure; cardiovascular disease; hypervolemia; outcome studies; risk factors