Blood Pressure Parameters and their Associations with Death in Patients with Chronic Kidney Disease.

PURPOSE OF REVIEW: Optimal blood pressure (BP) parameters among patients with chronic kidney disease (CKD) have been a matter of debate. This review critically evaluates recent literature to better define the associations of BP parameters and death among individuals with non-dialysis-dependent CKD.

RECENT FINDINGS: Observational studies report a "U- or J-shaped" association between BP and all-cause mortality in CKD and caution-intensive BP lowering in the elderly. Causes of death have been evaluated in a recent report noting higher cardiovascular and non-cardiovascular/non-malignant-related mortality among CKD population with SBP < 110 and > 150 mmHg. Very few randomized control trials evaluated the impact of different BP targets on patient-centered outcomes in those with CKD. Recently published SPRINT trial results suggest that intensive SBP control (<120 mm Hg) reduces cardiovascular events and all-cause death among non-diabetic patients with and without CKD. Clinical trial evidence supports lower BP target in those with mild to moderate non-diabetic CKD. However, clinical trials are warranted to further determine the beneficial effects of intensive blood pressure control in diabetic CKD population. In elderly population with CKD, BP targets might need to be individualized based on their comorbidities, life expectancy, and other factors.