Despite the guidelines, lower blood pressure might be unhealthy for kidney patients

Jun 24, 2010

Recent guidelines by The National Kidney Foundation Disease Outcomes Quality Initiative (NKF KDOQI)1 call for lower target blood pressure levels in patients with chronic kidney disease (CKD). But in the absence of high-quality scientific evidence, there's a chance this recommendation could do more harm than good, according to a special article appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN).

"The new goals are not definitively supported by data, would be costly to the healthcare system and potentially harmful to patients," according to Julia B. Lewis, MD (Vanderbilt University, Nashville, TN), who performed a critical review of the research evidence.

Issued last year, updated national guidelines for CKD treatment call for a target level of less than 130/80 mm Hg (millimeters of mercury) to help preserve . The recommendation was based on observational studies showing "a continuous benefit of reducing blood pressure to lower and lower levels."

However, Lewis points out several problems with the research behind the new guidelines. Most importantly, since patients in the observational studies were not randomly assigned to different blood pressure goals, the apparent benefit of lower blood pressures could result from other "confounding" factors. "The data supporting the current blood pressure guidelines for patients with CKD do not meet the standard of a primary outcome of a randomized trial," says Lewis.

She explains that, as kidney disease worsens, blood pressure rises and becomes harder to control. So the data may simply reflect the fact that patients with less severe kidney disease have lower blood pressure. In studies where patients were randomly assigned to treatments, the benefits of lower blood pressure were seen only in a subgroup of patients, or several years after the end of treatment.

"Also there is other evidence to bring into question the widespread application of this costly goal of a blood pressure less than 130/80 mm Hg," Lewis adds. Some studies have even suggested that CKD patients with very low blood pressure could be at increased risk of death.

A new trial sponsored by the National Institutes of Health (NIH) will compare the effects of different blood pressure targets in over 10,000 patients with CKD. Until the results are available, Lewis believes that doctors should make individualized decisions about blood pressure control for their patients with kidney disease.

Lewis emphasizes that no firm conclusions can be drawn from her review, since it was based on different types of studies with conflicting results.

Explore further: Restrictions lifted at British bird flu farm

More information: The article, entitled "Blood Pressure Control in Chronic Kidney Disease: Is Less Really More?" will appear online at doi:10.1681/ASN.2010030236

add to favorites email to friend print save as pdf

Related Stories

Blood pressure targets: Aiming lower offers no benefit

Jul 08, 2009

Aiming for lower than standard blood pressure targets offers no known clinical benefit, according to a Cochrane Review. In a systematic review of the evidence, researchers found that using antihypertensive drugs to reduce ...

Recommended for you

Restrictions lifted at British bird flu farm

22 hours ago

Britain on Sunday lifted all restrictions at a duck farm in northern England after last month's outbreak of H5N8 bird flu, the same strain seen in recent cases across Europe.

Recorded Ebola deaths top 7,000

Dec 20, 2014

The worst Ebola outbreak on record has now killed more than 7,000 people, with many of the latest deaths reported in Sierra Leone, the World Health Organization said as United Nations Secretary-General Ban ...

Liberia holds Senate vote amid Ebola fears (Update)

Dec 20, 2014

Health workers manned polling stations across Liberia on Saturday as voters cast their ballots in a twice-delayed Senate election that has been criticized for its potential to spread the deadly Ebola disease.

Evidence-based recs issued for systemic care in psoriasis

Dec 19, 2014

(HealthDay)—For appropriately selected patients with psoriasis, combining biologics with other systemic treatments, including phototherapy, oral medications, or other biologic, may result in greater efficacy ...

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.