According to the systematic review and meta-analysis conducted by Prof. Kuo-Liong Chien, Prof. Yu-Kang Tu, Dr. Hon-Yen Wu, and their PhD student, Dr. Wan-Chuan Tsai, at the College of Public Health in National Taiwan University, intensive blood pressure (BP) control below the current standard may not save kidneys in patients with chronic kidney disease (CKD). This study has been published online on 13 March 2017 in JAMA Intern Med.
[Photo (from left to right): Prof. Kuo-Liong Chien, Dr. Wan-Chuan Tsai, Dr. Hon-Yen Wu, and Prof. Yu-Kang Tu]
“For decades ago, the optimal BP target for preventing kidney disease progression remain debated in nondiabetic patients with CKD” said Dr. Tsai, the first author of the article who has accomplished this study during the first year of the PhD program.
The researchers stated that current clinical guidelines suggested a target of BP below 140/90 mmHg for patients with nondiabetic CKD and some suggested a further reduction to achieve a BP less than 130/80 mmHg for those with proteinuria. In this review and meta-analysis, they synthesized results from randomized clinical trials to examine the effects of intensive BP lowering treatment on major renal outcomes and mortality.
A total of nine randomized clinical trials with more than 8000 patients with kidney disease and over 800 clinical events were identified. Over a median follow-up of 3.3 years, targeting BP lower than current accepted level had no additional benefits on renal outcomes or death, but may benefit non-Blacks, or those with heavy proteinuria. The length of follow-up might not be long enough to distinguish outcome differences among the overall study population.
The finding of the review suggested an individually tailored approach rather than a general rule to control hypertension intensively in non-diabetic adults with CKD. Future studies with longer follow-up period should provide an answer if lower BP target can save our kidneys or not. At present, available evidence does not justify the routine use of intensive BP lowering strategy for the purpose of renoprotection in CKD patients