What is the evidence for the recommendation to lower blood pressure in children with CKD?
The evidence for this recommendation is based on a single randomized controlled trial (RCT) of 385 participants in which intensified blood pressure control (targeting 24-hour MAP <50th percentile of normal children) was compared to standard blood pressure control (targeting 24-hour MAP 50th-99th percentile of normal children). The study showed a probable benefit in slowing kidney disease progression and no greater risk of adverse events, such as hypotension or acute decrease in GFR. However, the study was not powered for, and did not demonstrate, differences in the critical outcome of all-cause mortality.