Hypertension is a common condition in chronic kidney disease (CDK) patients. Tight control of blood pressure (BP) is recommended to reduce premature cardiovascular disease in patients who undergo dialysis, but primary results of randomized controlled trials have so far failed to show any impact on progression of kidney disease by lowering BP.
Researchers at the University of California determined recently that strict BP control does not delay the onset of end-stage renal disease (ESRD) but may lower mortality after the onset of ESRD in CKD patients. Their analysis of two clinical trials (1995-2012), was published in the Journal of American Society of Nephrology under the title “BP Control and Long-Term Risk of ESRD and Mortality.”
The research team studied participants of two previously completed randomized and controlled trials of intensive blood pressure lowering: the Modification of Diet in Renal Disease study and the African American Study of Kidney Disease and Hypertension. The studies had already shown that intensive blood pressure lowering was not guaranteed to protect against kidney failure
By pooling the results of the studies that included more than 1,900 patients, the team found that having a lower blood pressure target of less than or greater than 92 mmHg compared to the currently guideline-recommended goal of 140–90 mmHg lowered the risk of premature death. The strategy also protected against kidney failure among the subset of CKD patients.
“The data that we provide include outcomes beyond the typical duration of clinical trials of blood pressure control and demonstrate the long-term safety of tighter blood pressure control, with potential benefits from a mortality standpoint in patients with known kidney disease,” study leader Elaine Ku said in a press release.
Blood pressure treatment targets are controversial despite proven benefits. While some clinical trials have shown that lowering systolic BP to less than 120 mm Hg improves heart health and longevity, other studies have suggested that lower BP levels may be harmful. Still, the recent analysis indicates that early control of BP could improve the overall health status and survival of ESRD patients.