New guidelines aim to help lower blood pressure in patients with chronic kidney disease

According to an analysis by researchers at the Johns Hopkins Bloomberg School of Public Health, a recommendation for more intensive blood pressure management from an influential global nonprofit that publishes clinical practice guidelines in kidney disease could , if followed, benefit nearly 25 million Americans.

New recommendation from Kidney Disease: Improving Global Outcomes, a global nonprofit that develops evidence-based clinical practice guidelines in kidney disease, is for physicians to help lower blood pressure in patients with chronic renal failure whose systolic blood pressure is greater than 120 mmHg. Blood pressure can be reduced by using antihypertensive drugs and lifestyle modifications. The analysis indicates that 69.5% of patients with chronic kidney disease in the United States – a total of 24.5 million people – would meet this criterion.

The study appears alongside the New Kidney Disease Guidelines: Improve Overall Outcomes (KDIGO) on Feb. 18 in the journal Kidney International.

“This is a major update to an influential set of guidelines for patients with chronic kidney disease, and it takes place against a backdrop of worsening blood pressure control in the United States. says Kathryn Foti, PhD, postdoctoral researcher in the Bloomberg School’s Department of Epidemiology.

Researchers estimate that more than 35 million people in the United States suffer from chronic kidney disease, a disease in which the kidneys are damaged and less and less effective at filtering waste products from the blood. Unfortunately, knowledge and diagnosis of kidney disease is poor. High blood pressure is a major cause of chronic kidney disease, a factor in its aggravation and a major risk factor for cardiovascular disease. Thus, it has long been considered important for patients with chronic kidney disease to maintain their blood pressure in the normal range, if necessary, with drugs including angiotensin converting enzyme (ACE) inhibitors. and angiotensin II receptor inhibitors (ARBs). With chronic kidney disease being so common, these new clinical guidelines could have a major impact on public health.

“Controlling blood pressure is especially important for one in seven people in the United States with chronic kidney disease,” says Josef Coresh, MD, PhD, professor George W. Comstock in the epidemiology department at Bloomberg School. “Reducing blood pressure in adults with chronic kidney disease to the level recommended in the new guidelines could also reduce cardiovascular disease in this group.

The researchers determined from their analysis that blacks and Asian Americans with chronic kidney disease are more likely than whites to have blood pressure readings above the 2020 target for Kidney Disease: Improve global results.

Normal healthy blood pressure is considered to be less than 120 mmHg systolic and 80 mmHg diastolic. The most recent recommendation from Kidney Disease: Improving Global Outcomes, in 2012, called for physicians to treat their patients with chronic kidney disease as needed to get their blood pressure readings to systolic 140 mmHg or below, and to 90 mmHg diastolic – and even lower,? 130 /? 80 mmHg, for people with albuminuria, a sign of protein in the urine of more severe chronic kidney disease. In 2017, the American College of Cardiology and the American Heart Association jointly published a recommendation to reduce blood pressure in patients with chronic kidney disease to 130 /? 80 mmHg.

In the study, researchers analyzed blood pressure and other data from a sample of 1,699 U.S. adults with chronic kidney disease in the 2015-2018 National Health and Nutrition Examination Survey to to assess the proportion of patients with chronic renal failure who could potentially benefit from the new KDIGO Guidelines.

Their main finding was that 69.5% of chronic kidney disease patients in the United States, or approximately 24.5 million people, are eligible for lower blood pressure according to the KDIGO 2020 guideline – compared to 49, 8% according to the 2012 Kidney Disease: Improving Global Outcomes and 55.6%, according to the 2017 guidelines of the American College of Cardiology / American Heart Association.

Thus, about seven million more chronic kidney disease patients are eligible for lowering blood pressure under the new guidelines compared to the 2012 guidelines on kidney disease: Improving global outcomes – and using the 2017 guidelines from the ‘American College of Cardiology / American Heart Association for comparison, about 5 million more are eligible.

The analysis suggests that at the time of the 2015-2018 National Health and Nutrition Survey, 14.4 million American adults with chronic kidney disease were not taking antihypertensive drugs. Of these, 61.8 percent, or roughly 8.9 million American adults, had systolic blood pressure levels above 120 mmHg and should therefore consider starting antihypertensive drugs under the new guidelines.

The authors note that blood pressure control has improved in the United States over most of the past two decades, although in recent years this trend has reversed.