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Blood pressure targets called in to question? Yes and No

Blood pressure targets called in to question? Yes and No

BP CuffIt is prevailing wisdom that patients with chronic kidney disease (CKD) progress more slowly if their blood pressure is well controlled. In fact, most modern guidelines suggest that for patients with CKD, a blood pressure of 130/80 should not be exceeded.

In the latest issue of the New England Journal of Medicine, investigators cast doubt on this widely-held belief. In this anticipated report, patients with CKD but without proteinuria (<300 mg per day) and blood pressure targets of 140/90 fared equally well to those with blood pressure targets of 130/80. However, in those with protein excretion above 300 mg per day, the lower blood pressure target was superior. The authors conclude that in non-proteinuric patients, we should be targeting a less stringent goal of <140/90.

While these data are very interesting, one should pay close attention to what was considered proteinuria. A cutoff of 300 mg per day is a very low threshold; meaning, that many patients with hypertension may still benefit from the lower target. This trial is a very welcome one but take care not to paint all hypertensive patients with the same brush.

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