What evidence is there to support a BP target of 130/80 mm Hg for kidney protection in patients with macroalbuminuria?
The evidence to support a BP target of 130/80 mm Hg for kidney protection in patients with macroalbuminuria comes from the AASK and MDRD studies, which showed a benefit from lower target BP in patients with PCR 4220 mg/g (422 mg/l). The ESCAPE trial also showed a benefit in the entire population with a borderline interaction of treatment target and urine protein level. The Ramipril Efficacy in Nephropathy 2 (REIN-2) study did not show a benefit of tight BP control, although it was a short-term study with relatively few outcomes and may have been confounded by the use of a dihydropyridine calcium-channel blocker (felodipine). The National Institutes of Health (NIH) funded Systolic Blood Pressure Intervention Trial (SPRINT) will evaluate cardiovascular and kidney outcomes in patients randomized to a systolic BP of o140 mm Hg versus o120 mm Hg.