A new approach to the consideration of hypertension in chronic kidney disease through the prism of the last KDIGO guide 2021

Abstract

Hypertension associated with chronic kidney disease (CKD) is related with a high risk of cardiovascular disease (CVD), which is the most common cause of morbidity and mortality in patients with CKD. Control of hypertension is important primarily because it reduces the risk of CVD and all-cause mortality in patients with CKD. The new KDIGO (Kidney Disease: Improving Global Outcomes) guideline for the management of blood pressure in CKD were published in 2021 and represented an updated version of the original guideline from 2012. This guideline covers all topics contained in the original instructions, such as optimal blood pressure targets, lifestyle interventions, choice of antihypertensive drugs, and specific management in kidney transplant recipients and children. Some aspects of general and cardiovascular health, such as lipid control and smoking, are excluded. In addition, this guideline introduces a chapter dedicated to proper blood pressure measurement as all large randomized trials from which the evidence and recommendations of this guide emerged used standardized preparation and measurement protocols adhered to by patients and clinicians. The key recommendation of the KDIGO guideline refers to target systolic blood pressure under120 mmHg in most adults with CKD, provided that the standardized office blood pressure measurement is used. Despite recommendations for lowering target blood pressure, general lack of evidence, especially in patients with diabetes and advanced CKD, still suggests the need to individualize targets according to the characteristics, tolerances, and preferences of each patient. Larger randomized controlled trials are needed to examine the effects of blood pressure targets on major adverse events and mortality in patients with CKD, especially in subpopulations that were not adequately represented in previous studies.