The Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for management of blood pressure (BP) in chronic kidney disease (CKD) supersedes the 2004 Kidney Disease Quality Outcomes Initiative document on this topic. The new guideline has been designed to assist clinical decision making in patients with CKD who are not receiving dialysis. The recommendations in the guideline acknowledge that no single BP target is optimal for all CKD patients and encourage individualization of treatment depending on age, the severity of albuminuria, and comorbidities.
In general, the available evidence indicates that in CKD patients without albuminuria the target BP should be less than or equal to140?mm?Hg systolic and less than or equal to90?mm?Hg diastolic. However, in most patients with an albumin excretion rate of greater than or equal to30?mg/24?h (i.e., those with both micro- and macroalbuminuria), a lower target of less than or equal to130?mm?Hg systolic and less than or equal to80?mm?Hg diastolic is suggested. In achieving BP control, the value of lifestyle changes and the need for multiple pharmacological agents is acknowledged. Use of agents that block the renin–angiotensin–aldosterone system is recommended or suggested in all patients with an albumin excretion rate of greater than or equal to30?mg/24?h. Recommendations are almost identical in CKD patients with and without diabetes. Special considerations relevant to children and those of older age and those who have received a kidney transplant are included. Ongoing controversies in BP management in the context of CKD are highlighted along with key areas for future research.
David C Wheeler and Gavin J Becker
Kidney Int 2013 83: 377-383; advance online publication, January 16, 2013;
10.1038/ki.2012.425
http://www.nature.com/ki/journal/v83/n3/full/ki2012425a.html
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Language:
English -
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KI -
Year:
2013 -
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