What evidence exists to support the use of BP-lowering drugs in non-diabetic adults with CKD ND and urine albumin excretion 4300 mg per 24 hours?
There is evidence from randomized controlled trials (RCTs) that maintaining a BP of r130/80 mm Hg may reduce progression of CKD in patients with urine albumin excretion 4300 mg per 24 hours (macroalbuminuria). Additionally, observational data suggests that hypertension is a risk factor for both CVD and progression of CKD in patients with macroalbuminuria. Short-term follow-up data from the MDRD study showed an interaction of BP target with the level of urine protein, with a definitive benefit in patients with a urine protein level 41 g per 24 hours. Long-term follow-up data from AASK also showed a benefit of a lower target BP in patients with PCR 4220 mg/g (422 mg/24h) and the ESCAPE trial14 showed a benefit in the entire population with a borderline interaction of treatment target and urine protein level.