Optimal Targets for Blood Pressure Control in CKD
Three clinical practice guideline teams have recently summarized the evidence on BP targets in CKD and made recommendations. Fortunately for the practising physician, the two more recent guidelines are consistent with the 2012 KDIGO guideline, so all three documents offer essentially identical advice. This is quite a bit better than the situation with multiple conflicting guidelines for the management of hypertension in the general population.
The Australasian KHA-CARI guideline on cardiovascular disease in CKD includes a section on BP management. The recommended target is 140/90 unless macroalbuminuria is present, in which case a target of 130/80 is recommended. They note the lack of evidence for managing dialysis patients.
The new American JNC8 guideline for BP management in the general population includes a well-argued section on managing patients with CKD; the recommendations are virtually the same as KHA-CARI and the earlier KDIGO.
The 2012 publication of the KDIGO guideline on BP management in CKD has launched a small tidal wave of commentaries and regional responses: from the working group chairs themselves, the Americans, the Europeans, the Canadians, the Australians and individual opinion leaders. The suggested changes to suit local practice are minor, and it is fair to say that they have been widely accepted and implemented.
Guidelines and Guideline Commentaries
Three clinical practice guideline teams have recently summarized the evidence on BP targets in CKD and made recommendations. Fortunately for the practising physician, the two more recent guidelines are consistent with the 2012 KDIGO guideline, so all three documents offer essentially identical advice. This is quite a bit better than the situation with multiple conflicting guidelines for the management of hypertension in the general population.
The Australasian KHA-CARI guideline on cardiovascular disease in CKD includes a section on BP management. The recommended target is 140/90 unless macroalbuminuria is present, in which case a target of 130/80 is recommended. They note the lack of evidence for managing dialysis patients.
The new American JNC8 guideline for BP management in the general population includes a well-argued section on managing patients with CKD; the recommendations are virtually the same as KHA-CARI and the earlier KDIGO.
The 2012 publication of the KDIGO guideline on BP management in CKD has launched a small tidal wave of commentaries and regional responses: from the working group chairs themselves, the Americans, the Europeans, the Canadians, the Australians and individual opinion leaders. The suggested changes to suit local practice are minor, and it is fair to say that they have been widely accepted and implemented.
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