Ashish Upadhyay, MD; Katrin Uhlig, MD, MS
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-2790.
Upadhyay A, Uhlig K. Blood Pressure Target in Chronic Kidney Disease and Proteinuria as an Effect Modifier. Ann Intern Med. 2011;155:208. doi: 10.7326/0003-4819-155-3-201108020-00029
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Published: Ann Intern Med. 2011;155(3):208.
In response to our systematic review of BP targets in CKD trials, Drs. Schrier and Lumlertgul ask whether a lower BP target would benefit patients with CKD and diabetes. They cite the ACCORD and ABCD studies, which we did not include in our review because only one third of participants had CKD on the basis of elevated urinary albumin excretion (about two thirds with microalbuminuria) (1, 2). The ACCORD study did not find a systolic BP target of less than 120 mm Hg to be more beneficial than a target of less than 140 mm Hg for a composite of clinical outcomes. The ABCD trial compared an intensive BP goal (10 mm Hg below the baseline diastolic BP; mean achieved, 128/75 mm Hg) with a more moderate BP goal (diastolic BP of 80 to 89 mm Hg; mean achieved, 137/81 mm Hg) and found benefit for proteinuria but not for kidney function and major cardiovascular outcomes.
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