A Low Blood Pressure Target Prevented Kidney Failure in Patients with Chronic Kidney Disease FREE

Chronic kidney disease is a gradual and progressive loss of function in both kidneys. Many patients with chronic kidney disease have high blood pressure. Doctors usually use drugs to reduce blood pressure and decrease risks for heart attacks, strokes, and kidney failure. Most experts recommend reducing blood pressure to less than 140/90 mm Hg in adults with high blood pressure. In adults with certain conditions, such as diabetes or chronic kidney disease, experts often recommend reducing blood pressure to less than 130/80 mm Hg. No long-term clinical trials have tested whether reducing blood pressure to the lower levels prevents kidney failure in patients with chronic kidney disease.

To see whether a low blood pressure target prevents kidney failure in patients with chronic kidney disease.

840 middle-aged adults with mild to moderate chronic kidney disease from causes other than diabetes. The average blood pressure at study entry was about 130/80 mm Hg because many patients were already taking drugs that reduced blood pressure.

The researchers used a national database (the U.S. Renal Data System) to see whether patients who had participated in a trial from 1989 to 1993 later developed kidney failure until 2000. In the initial trial, researchers randomly assigned patients to either a low blood pressure target (less than 125/75 mm Hg) or a usual blood pressure target (less than 140/90 mm Hg). They measured patients' blood pressures monthly and adjusted treatment as needed to help patients meet the target blood pressure goals. During the initial trial period, they achieved average blood pressure levels of about 126/77 mm Hg in the low target group and 134/81 mm Hg in the usual target group. Then, the researchers compared numbers of people in each group who later developed kidney failure until 2000. Kidney failure was defined as the need for dialysis or a kidney transplant.

Fewer patients (62%) in the low blood pressure target group developed kidney failure than did those (70%) in the usual blood pressure group.

The researchers did not track patients' blood pressures after the original trial ended in 1993. We do not know whether patients assigned to the low blood pressure target group maintained their relatively low blood pressures over time.

Targeting a low blood pressure goal of less than 130/80 mm Hg may prevent kidney failure in some adults with mild to moderate chronic kidney disease.