Targeting the Standardized Blood Pressure: New Guidelines for Blood Pressure Management in Chronic Kidney Disease
Authors: George Thomas, Crystal A. Gadegbeku
Journal: Annals of Internal Medicine (2021)

EditorialsSeptember 2021Targeting the Standardized Blood Pressure: New Guidelines for Blood Pressure Management in Chronic Kidney DiseaseGeorge Thomas, MD and Crystal A. Gadegbeku, MDGeorge Thomas, MDGlickman Urological and Kidney Institute, Cleveland Clinic Cleveland, OhioSearch for more papers by this author and Crystal A. Gadegbeku, MDGlickman Urological and Kidney Institute, Cleveland Clinic Cleveland, OhioSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-2571 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Hypertension is common and challenging to treat among patients with chronic kidney disease (CKD). Recent evidence for cardiovascular benefit with more intensive management of blood pressure (BP) in high-risk hypertensive populations, including those with CKD, has led to recommendations of lower, yet evolving, BP targets (1, 2). In their article, Tomson and colleagues (3) summarize the 2021 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease, which addresses BP management in adults with CKD who are not receiving dialysis and have not had a kidney transplant. Tomson and colleagues' synopsis ...References1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13-e115. [PMID:29133356] doi:10.1161/HYP.0000000000000065 CrossrefMedlineGoogle Scholar2. Williams B, Mancia G, Spiering W, et al; ESC Scientific Document Group. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021-3104. [PMID:30165516] doi:10.1093/eurheartj/ehy339 CrossrefMedlineGoogle Scholar3. Tomson CRV, Cheung AK, Mann JFE, et al. Management of blood pressure in patients with chronic kidney disease not receiving dialysis: synopsis of the 2021 KDIGO clinical practice guideline. Ann Intern Med. 2021;174:1270-81. doi:10.7326/M21-0834 Google Scholar4. Cheung AK, Rahman M, Reboussin DM, et al; SPRINT Research Group. Effects of intensive BP control in CKD. J Am Soc Nephrol. 2017;28:2812-2823. [PMID:28642330] doi:10.1681/ASN.2017020148 CrossrefMedlineGoogle Scholar5. Cushman WC, Evans GW, Byington RP, et al; ACCORD Study Group. Effects of intensive blood-pressure control in type 2 diabetes mellitus. N Engl J Med. 2010;362:1575-85. [PMID:20228401] doi:10.1056/NEJMoa1001286 CrossrefMedlineGoogle Scholar6. Foti KE, Wang D, Chang AR, et al. Potential implications of the 2021 KDIGO blood pressure guideline for adults with chronic kidney disease in the United States. Kidney Int. 2021;99:686-695. [PMID:33637204] doi:10.1016/j.kint.2020.12.019 CrossrefMedlineGoogle Scholar7. Agarwal R, Rossignol P, Romero A, et al. Patiromer versus placebo to enable spironolactone use in patients with resistant hypertension and chronic kidney disease (AMBER): a phase 2, randomised, double-blind, placebo-controlled trial. Lancet. 2019;394:1540-1550. [PMID:31533906] doi:10.1016/S0140-6736(19)32135-X CrossrefMedlineGoogle Scholar8. Bhandari S, Ives N, Brettell EA, et al. Multicentre randomized controlled trial of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker withdrawal in advanced renal disease: the STOP-ACEi trial. Nephrol Dial Transplant. 2016;31:255-61. [PMID:26429974] doi:10.1093/ndt/gfv346 CrossrefMedlineGoogle Scholar9. Bakris GL, Agarwal R, Anker SD, et al; FIDELIO-DKD Investigators. Effect of finerenone on chronic kidney disease outcomes in type 2 diabetes. N Engl J Med. 2020;383:2219-2229. [PMID:33264825] doi:10.1056/NEJMoa2025845 CrossrefMedlineGoogle Scholar10. Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al; DAPA-CKD Trial Committees and Investigators. Dapagliflozin in patients with chronic kidney disease. N Engl J Med. 2020;383:1436-1446. [PMID:32970396] doi:10.1056/NEJMoa2024816 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Glickman Urological and Kidney Institute, Cleveland Clinic Cleveland, OhioDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-2571.Corresponding Author: Crystal A. Gadegbeku, MD, Cleveland Clinic, 9500 Euclid Avenue, Q7-100B, Cleveland, OH 44195.Current Author Addresses: Drs. Thomas and Gadegbeku: Cleveland Clinic, 9500 Euclid Avenue, Q7-100B, Cleveland, OH 44195.This article was published at Annals.org on 22 June 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoManagement of Blood Pressure in Patients With Chronic Kidney Disease Not Receiving Dialysis: Synopsis of the 2021 KDIGO Clinical Practice Guideline Charles R.V. Tomson , Alfred K. Cheung , Johannes F.E. Mann , Tara I. Chang , William C. Cushman , Susan L. Furth , Fan Fan Hou , Gregory A. Knoll , Paul Muntner , Roberto Pecoits-Filho , Sheldon W. Tobe , Lyubov Lytvyn , Jonathan C. Craig , David J. Tunnicliffe , Martin Howell , Marcello Tonelli , Michael Cheung , Amy Earley , Joachim H. Ix , and Mark J. Sarnak Management of Blood Pressure in Patients With Chronic Kidney Disease Not Receiving Dialysis: Synopsis of the 2021 KDIGO Clinical Practice Guideline Charles R.V. Tomson , Alfred K. Cheung , Johannes F.E. Mann , Tara I. Chang , William C. Cushman , Susan L. Furth , Fan Fan Hou , Gregory A. Knoll , Paul Muntner , Roberto Pecoits-Filho , Sheldon W. Tobe , Lyubov Lytvyn , Jonathan C. Craig , David J. Tunnicliffe , Martin Howell , Marcello Tonelli , Michael Cheung , Amy Earley , Joachim H. Ix , and Mark J. Sarnak Metrics September 2021Volume 174, Issue 9Page: 1321-1322KeywordsBlood pressureChronic kidney diseaseHypertensionKidneysPatientsRenal diseasesRenal failure ePublished: 22 June 2021 Issue Published: September 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...