Robert W. Schrier, MD; Nuttha Lumlertgul, MD
Potential Conflicts of Interest: None disclosed.
Schrier R., Lumlertgul N.; Blood Pressure Target in Chronic Kidney Disease and Proteinuria as an Effect Modifier. Ann Intern Med. 2011;155:207-208. doi: 10.7326/0003-4819-155-3-201108020-00028
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Published: Ann Intern Med. 2011;155(3):207-208.
TO THE EDITOR:
The recent review by Uhlig and colleagues (1) concluded that reports from randomized, controlled trials from July 2001 to January 2011 do not provide conclusive evidence that a blood pressure (BP) target less than 130/80 mm Hg improves clinical outcomes more than a target of less than 140/90 mm Hg in patients with stage 3 and stage 4 chronic kidney disease (CKD) As major limitations of their review, the authors cite that no study included patients with diabetes and that trial durations may have been too short (mean follow-up, 2 to 4 years) to detect some clinical outcomes. This report raises 3 important questions: Would the lower BP goal have improved outcomes in diabetic patients with CKD? Would earlier intervention (for example, stage 2 CKD) demonstrate improved clinical outcomes with the lower BP goal? Would longer follow-up demonstrate improved clinical outcome with the lower BP goal?
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