Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

Which target blood pressure is optimal for renoprotection?

Nature Clinical Practice Nephrology volume 2, pages 58–59 (2006)Cite this article

Over the past 20 years, there has been a growing consciousness that elevated blood pressure is of overriding importance in the progression of chronic kidney disease (CKD). The MRFIT trial revealed that elevated blood pressure is a strong and independent risk factor for the development of end-stage renal disease (ESRD).1 The association of high blood pressure with progression of renal disease has also been demonstrated in numerous observational studies,2 and several uncontrolled trials have shown that antihypertensive medication slows the progression of CKD.

These findings prompted the questions of whether all renal diseases are similarly sensitive to high blood pressure and whether they benefit similarly from antihypertensive therapy. Analyzing the data from the MDRD study, Peterson et al.3 found that reduction of mean arterial pressure to 92–98 mm Hg improved renal prognosis in patients with CKD and proteinuria (>1 g/day), even further than reduction of mean arterial pressure to 107–113 mm Hg. This was not, however, seen in patients with lower levels of proteinuria.3 Proteinuria apparently sensitized the kidney to elevated blood pressure. These results were confirmed by Jafar et al. in a meta-analysis comparing the effects of antihypertensive therapy, with or without ANGIOTENSIN-CONVERTING-ENZYME INHIBITORS (ACEIs), on the progression of renal insufficiency.4 Interestingly, they found that reducing systolic blood pressure slows the progression of CKD more effectively than reducing diastolic blood pressure.5

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Klag MJ et al. (1996) Blood pressure and end-stage renal disease in men. N Engl J Med 334: 13–18

    Article  CAS  Google Scholar 

  2. Oldrizzi L et al. (1993) The place of hypertension among the risk factors for renal function in chronic renal failure. Am J Kidney Dis 21 (Suppl 2): 119–123

    Article  CAS  Google Scholar 

  3. Peterson JC et al. (1995) Blood pressure control, proteinuria and the progression of renal disease: the Modification of Diet in Renal Disease Study. Ann Intern Med 123: 754–762

    Article  CAS  Google Scholar 

  4. Jafar TH et al. (2003) Progression of chronic kidney disease: the role of blood pressure control, proteinuria, and angiotensin-converting enzyme inhibition: a patient-level meta-analysis. Ann Intern Med 139: 244–252

    Article  CAS  Google Scholar 

  5. He J et al. (1999) Elevated systolic blood pressure and risk of cardiovascular and renal disease: overview of evidence from observational epidemiologic studies and randomized controlled trials. Am Heart J 138: 211–219

    Article  CAS  Google Scholar 

  6. Wright JT Jr et al. (2002) Effect of blood pressure lowering and antihypertensive drug class on progression of hypertensive kidney disease: results from the AASK trial. JAMA 288: 2421–2431

    Article  CAS  Google Scholar 

  7. Sarnak MJ et al. (2005) The effect of a lower target blood pressure on the progression of kidney disease: long-term follow-up of the Modification of Diet in Renal Disease study. Ann Intern Med 142: 342–351

    Article  Google Scholar 

  8. Ruggenenti P et al. (2005) Blood-pressure control for renoprotection in patients with non-diabetic chronic renal disease (REIN-2): multicentre, randomised controlled trial. Lancet 365: 939–946

    Article  Google Scholar 

  9. Textor SC et al. (1985) Critical perfusion pressure for renal function in patients with bilateral atherosclerotic renal vascular disease. Ann Intern Med 102: 308–314

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Internal Medicine and Nephrology and Head of Department, all in the Department of Nephrology, Endocrinology and Metabolic Diseases, Medical University of Silesia, Katowice, Poland

    Marcin Adamczak, Jerzy Chudek & Andrzej Więcek

Authors
  1. Marcin Adamczak
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jerzy Chudek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andrzej Więcek
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrzej Więcek.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Adamczak, M., Chudek, J. & Więcek, A. Which target blood pressure is optimal for renoprotection?. Nat Rev Nephrol 2, 58–59 (2006). https://doi.org/10.1038/ncpneph0092

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpneph0092

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing