BP Targets in Older Adults with CKD: Additional Evidence, but Uncertainty Continues

[摘要] Hypertension is a global health problem that contributes significantly to the cardiovascular and kidney disease morbidity and mortality of our aging population. In this context, it is clear that BP increases not only as we age but also as kidney function starts to decline (1). There have been a number of efforts in recent years by several societies to issue guidance for clinicians in hypertensive management in this high-risk population of older adults with CKD (2). The most recent report from the panel members appointed to the Eighth Joint National Committee recommend a BP target of <150/90 mmHg for all adults aged ≥60 years and <140/90 mmHg for those aged <60 years (3). However, there was disagreement among the panel members with some suggesting a target of <140 mmHg or lower for all adults aged >60 years (4,5). In the context of the aging patient with CKD, recent observational studies questioned the utility of lowering systolic BP (SBP) <130 mm Hg for all patients irrespective of age (6,7). The Kidney Disease Improving Global Outcomes (KDIGO) Blood Pressure in CKD work group recommends a target BP of ≤140/90 mmHg in those with CKD (both diabetic and nondiabetic) and urine albumin excretion <30 mg/24 h and suggests a target BP of ≤130/80 mmHg in those with CKD (both diabetic and nondiabetic) and urine albumin excretion >30 mg/24 h irrespective of age (grade 2D). The KDIGO guidelines did not recommend a specific BP target for elderly persons with nondialysis-dependent CKD because of a lack of conclusive evidence.

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome