What are the implications of the recent RCTs related to BP control in CKD populations?
Recent RCTs have suggested that there may be adverse implications associated with tighter BP control in the elderly and those with CAD and low diastolic BP. Furthermore, less tight control may improve adherence and reduce costs of treatment. Additionally, some analyses have shown that there may be worse outcomes in those targeted to low BP when the urine protein/creatinine ratio (PCR) is r220 mg/g (r22 mg/mmol). Finally, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study did not show a benefit of a systolic BP target of o120 mmHg versus a target of o140 mmHg. Therefore, current BP targets recommended in the general population may need to be extrapolated to those with CKD who do not have elevated urinary albumin or protein levels.