Lower BP in CKD Helps Only When Proteinuria is Present
Intensive BP control is no better than standard BP control at protecting against progression of kidney disease among African Americans with CKD, except perhaps if proteinuria also is present, according to findings published in the New England Journal of Medicine (2010;363:918-929).
In African Americans with CKD and proteinuria (protein-to-creatinine ratio above 0.22), BP lower than 130/80 mm Hg is associated with a significant 27% decrease in the risk of a CKD progression, defined as a doubling of serum creatinine, a diagnosis of end-stage renal disease, or death.
The results are based on a three-year study involving 1,094 African-Americans with hypertensive CKD. Subjects were randomly assigned to receive standard or intensive BP control. After an initial trial phase, patients were invited to enroll in a cohort in which the BP target was below 130/80. During the trial phase, the mean BP was 130/78 in the intensive-control group and 141/86 in the standard-control group. During the cohort phase, the mean BP was 131/78 and 134/78, respectively.