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Guiding Lights for Antihypertensive Treatment in Patients with Nondiabetic Chronic Renal Disease: Proteinuria and Blood Pressure Levels?

Cynthia D. Mulrow, MD, MSc, Deputy Editor; and Raymond R. Townsend, MD, Associate Editor
[+] Article, Author, and Disclosure Information

From University of Pennsylvania, Philadelphia, PA 19104.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Customer Service, American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.

Current Author Addresses: Dr. Mulrow: American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106-1572.

Dr. Townsend: University of Pennsylvania, 210 White Building, 3400 Spruce Street, Philadelphia, PA 19104.

Ann Intern Med. 2003;139(4):296-298. doi:10.7326/0003-4819-139-4-200308190-00013
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In the United States, about 20 million adults have chronic kidney disease (1). Many also have hypertension, either as a cause or complication of the kidney disease. Recently released guidelines from the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recommended aggressive treatment of hypertension to target blood pressure values less than 130/80 mm Hg in patients with chronic kidney disease (2). The guidelines defined chronic kidney disease as either reduced excretory function (estimated glomerular filtration rate < 60 mL/min per 1.73 m2, corresponding approximately to a creatinine level > 132.6 µmol/L [>1.5 mg/dL] in men or >114.9 µmol/L [>1.3 mg/dL] in women) or the presence of urinary findings, such as albuminuria (>300 mg/d or 200 mg of albumin per g of creatinine). Stated goals of aggressive blood pressure management were to slow deterioration of renal function and prevent cardiovascular disease. Angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers were listed as first-line agents of choice for patients with either diabetic or nondiabetic renal disease. The guidelines did not address whether the target blood pressure should vary depending on severity of renal disease.

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