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Behavior of albuminuria in patients with a more intense control of their blood pressure

Hypertension Research volume 46, pages 1821–1822 (2023)Cite this article

First of all I want to congratulate the authors Kyung Won Kim, Hee Byung Koh et al. for the article published in their journal [1]: “Systolic blood pressure, low-density lipoprotein cholesterol levels, and adverse kidney outcome: results from KNOW-CKD1”. My congratulations are due to the exhaustiveness of the work and the novel hypothesis raised in it about the importance of the degree of control of blood pressure and LDL cholesterol together in a cohort of patients and their evolution to progression in chronic kidney disease or renal replacement therapy.

The influence of better blood pressure control on vascular risk, as well as LDL levels, has been studied with mixed results, but not as much has been done in the evolution to chronic kidney disease, where LDL cholesterol levels have not been raised as modifiers of renal disease, if the decrease or better control of blood pressure has been associated with decreased filtration, but not with progression or renal replacement therapy. The results are disparate in different studies, and it is not possible to make a clear recommendation on the ideal blood pressure control figure despite the efforts of the KDIGO [2] guidelines, or the recommendations for chronic kidney disease and hypertension of the European [3] 2018 ESC/ESH guidelines. Nor is it resolved in which pathologies, ages and profiles a more exhaustive or less control is better.

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References

  1. Kim KW, Koh HB, Kim HW, Park JT, Yoo TH, Kang SW. et al. Systolic blood pressure, low-density lipoprotein cholesterol levels, and adverse kidney outcome: results from KNOW-CKD. Hypertens Res. 2023. https://doi.org/10.1038/s41440-023-01230-0.

  2. KDIGO 2021 Clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppl. 2021;99:S1-87. Retrieved from: https://kdigo.org/wp-content/uploads/2016/10/KDIGO-2021-BP-GL.pdf.

  3. Williams B, Mancia. et al. Guía ESC/ESH 2018 sobre el diagnóstico y tratamiento de la hipertensión arterial. Rev Esp Cardiol. 2019;72:160.e1–e78. https://www.revespcardiol.org/es-guia-esc-esh-2018-sobre-el-articulo-S0300893218306791.

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  4. Nadkarni GN, Chauhan K, Rao V, Ix JH, Shlipak MG, Parikh CR. et al. Effect of intensive blood pressure lowering on kidney tubule injury: findings from the ACCORD Trial study participants. Am J Kidney Dis. 2019;73:31–38. https://www.sciencedirect.com/science/article/abs/pii/S0272638618308801.

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  5. Upadhyay A, Earley A, Haynes SM, Uhlig K. Systematic review: blood pressure target in chronic kidney disease and proteinuria as an effect modifier. Ann Intern Med. 2011;154:541–8. https://www.acpjournals.org/doi/10.7326/0003-4819-154-8-201104190-00335.

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  1. Grupo de Trabajo HTA semFYC, Barcelona, Spain

    Miguel Angel Maria-Tablado

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  1. Miguel Angel Maria-Tablado
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Correspondence to Miguel Angel Maria-Tablado.

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Maria-Tablado, M.A. Behavior of albuminuria in patients with a more intense control of their blood pressure. Hypertens Res 46, 1821–1822 (2023). https://doi.org/10.1038/s41440-023-01275-1

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