title: Blood Pressure Targets in CKD: Lessons Learned from SPRINT and Previous Observational Studies.
abstract: Hypertension management is one of the most common clinical tasks in the care of patients with chronic kidney disease (CKD). Elevated blood pressure (BP) is associated with greater risk of all-cause mortality, cardiovascular (CV) disease, and CKD progression in this population. However, it is still debated, to what target(s) BP should be lowered in patients with signs of kidney damage. The Systolic Blood Pressure Intervention Trial (SPRINT) provided new and important information about the effects of lowering systolic BP to a target of <120 mmHg, which is lower than the levels currently recommended by the most guidelines (<140/90 mmHg). The SPRINT results were not only exciting but also surprising for many clinicians because evidence from well-conducted observational studies in CKD patient showed increased mortality in patients with CKD whose office systolic BP levels were <120 mmHg, as compared with systolic BP in 120-139 mmHg range. In the present review, we will discuss whether a systolic BP goal of <120 mmHg that was found to be beneficial for CV and all-cause mortality outcomes in the SPRINT can be generalized to the entire CKD population.
authors.affiliation: Nephrology Division, Department of Medicine, Albany Medical College, Albany, NY, USA.|Nephrology Section, Stratton VA Medical Center, Albany, NY, USA.
authors.forename: Elvira O
authors.initials: EO
authors.lastname: Gosmanova
authors.affiliation: Nephrology Division, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. ckovesdy@uthsc.edu.|Nephrology Section, Memphis VA Medical Center, 1030 Jefferson Ave., Memphis, TN, 38104, USA. ckovesdy@uthsc.edu.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
mesh_terms: D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D006977:Hypertension, Renal / Q000188:drug therapy* / Q000503:physiopathology; D064887:Observational Studies as Topic; D016032:Randomized Controlled Trials as Topic; D051436:Renal Insufficiency, Chronic / Q000503:physiopathology*; D018570:Risk Assessment
chemical_list: D000959:Antihypertensive Agents
keywords: Blood pressure; CKD; SPRINT