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Invited Commentary
October 2017

The Ideal Blood Pressure Target for Patients With Chronic Kidney Disease—Searching for the Sweet Spot

Author Affiliations
  • 1Division of Nephrology, University of Tennessee Health Science Center, Memphis
  • 2Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
JAMA Intern Med. 2017;177(10):1506-1507. doi:10.1001/jamainternmed.2017.4467

Hypertension is the number 1 cardiovascular risk factor, and its treatment prevents major cardiovascular events and lowers mortality. Most patients with chronic kidney disease (CKD) have hypertension, and CKD is characterized by extremely high cardiovascular disease rates. It is thus not surprising that antihypertensive therapy is a universal part of CKD management, and its benefits are broadly accepted. Notwithstanding the general consensus about the pathophysiologic relevance of hypertension, there has been controversy in the medical community regarding the ideal therapeutic blood pressure (BP) target in patients with CKD. Fueling this controversy are concerns about the presence of a J-curve and the paucity of dedicated randomized clinical trials (RCTs) testing the effects of BP lowering to levels that approach physiologic normalcy (ie, <120/80 mm Hg). These uncertainties are further accentuated when assessing the effects of antihypertensive therapy on all-cause mortality, which includes deaths with causes entirely unrelated to hypertension.

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