Abstract
Cardiovascular (CV) diseases remain the main reason for mortality and morbidity among patients with or without chronic kidney disease (CKD) and hypertension represents one of their risk factor. Despite the lack of definitive evidence that intensive blood pressure (BP) lowering improves kidney function outcomes, we agree with the recommendation of target BP < 130/80 mm Hg in most adults with CKD for the purpose of CV disease prevention.
SPRINT trial showed that more intensive systolic BP control decreased the incidence of CV events and death, including in patients with CKD. On the other hand, intensive BP control may lead to a slightly faster decline in eGFR and increased AKI (acute kidney injury) incidence.
These adverse events (AE) are usually reversible, of low absolute magnitude, but of unclear clinical relevance, and, furthermore, with certain impact of economy in AE treatment. Patients with chronic heart failure, with advance CKD and seniors generally belong to the most risky groups.
Thus, we can conclude, the benefit of intensive BP control will, in most circumstances, outweigh kidney and other adverse outcomes, but the intensity of BP control and BP targets should be individualised and should respect specific risk/benefit ratio of each single patient.