The African American Study of Kidney Disease: do these results indicate that 140/90 mm hg is good enough?

Current national guidelines recommend aggressive lowering of blood pressure (< 130/80 mm Hg) in patients with chronic kidney disease (CKD). In this paper, we summarize recent clinical trial data evaluating the effect of lower blood pressure goals on renal outcomes. The epidemiologic data relating...

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Bibliographic Details
Published in:Current hypertension reports 2005-10, Vol.7 (5), p.363-366
Main Authors: Rahman, Mahboob, El-Meanawy, Ashraf, Romanello, Joseph
Format: Article
Language:English
Subjects:
African Americans
Antihypertensive Agents - therapeutic use
Blood pressure
Clinical trials
Disease Progression
Glomerular Filtration Rate
Humans
Hypertension
Hypertension - complications
Hypertension - drug therapy
Kidney diseases
Kidney Failure, Chronic - complications
Kidney Failure, Chronic - prevention & control
Medical treatment
Meta-Analysis as Topic
Proteinuria - complications
Proteinuria - prevention & control
Randomized Controlled Trials as Topic
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Summary:Current national guidelines recommend aggressive lowering of blood pressure (< 130/80 mm Hg) in patients with chronic kidney disease (CKD). In this paper, we summarize recent clinical trial data evaluating the effect of lower blood pressure goals on renal outcomes. The epidemiologic data relating blood pressure to progression of kidney disease, the Modification of Diet in Renal Disease (MDRD) study (in patients with > 1 g proteinuria/d), and meta-analyses of angiotensin-converting enzyme (ACE) inhibitor clinical trials all support lower blood pressure goals in CKD patients, particularly those with proteinuria. The African American Study of Kidney Disease and Hypertension (AASK) supports lower blood pressure goals in terms of reduction of proteinuria, but demonstrates no additional benefit for clinical renal outcomes. Similarly, the second Ramipril Efficacy in Nephropathy study (REIN-2) shows that in patients with proteinuric nondiabetic renal disease who are receiving ACE inhibitors, a lower than usual blood pressure goal does not improve renal outcomes. However, there are limited clinical trial data evaluating the effects of low blood pressure on the increased cardiovascular risk seen in patients with CKD. Pending further clinical studies, current recommendations to target tight blood pressure control (< 130/80 mm Hg) in patients with CKD appear reasonable.
ISSN:1522-6417
1534-3111
DOI:10.1007/s11906-005-0072-6