What are the risk and benefit ratios associated with aggressive BP control in different subpopulations?
The risk benefit ratio associated with aggressive BP control in different subpopulations may vary. For example, in the ESCAPE trial, targeting the intensified BP control required a larger number of antihypertensive agents than the conventional target, which may be a burden for some children. Certain subgroups, those with glomerular disorders, GFR <45 ml/, and those with PCR >1.5 g/g (150 mg/ mmol) seemed to benefit the most. However, those with a PCR <0.5 g/g (50 mg/ mmol) did not have a significant benefit from strict BP control. Therefore, individuals who are prone to become dehydrated and are at risk of AKI may have a higher risk of adverse events with aggressive BP control. The 2016 European Society of Hypertension guideline recommends targeting the 75th percentile of MAP of normal children in a CKD patient with no proteinuria, and the 50th percentile if an individual has proteinuria.