What is the recommendation for lowering systolic blood pressure (SBP) from 120-129 mm Hg to less than 120 mm Hg?
The recommendation of lowering SBP from 120-129 mm Hg to less than 120 mm Hg by pharmacologic or non-pharmacologic means is tentative. This is due to the lack of randomized controlled trials (RCTs) in CKD targeting SBP less than 120 mm Hg that have included individuals with SBP of 120-129 mm Hg. Observational data suggests that individuals with SBP of 120-129 mm Hg are at higher cardiovascular (CV) risk than those with SBP less than 120 mm Hg, so theoretically, intensive BP lowering could be beneficial. However, the SPRINT study found that the subgroup with the lowest diastolic blood pressure (DBP) at baseline had similar CV and survival benefits from intensive SBP reduction as those with higher baseline DBP.