Blood pressure targets for hypertension in people with chronic renal disease

Abstract

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Primary objective To assess the effects of lower or standard blood pressure targets for hypertensive patients with CKD on mortality and morbidity outcomes. ’Lower targets’ are defined as blood pressure targets ≤ 130/80 mmHg. ’Standard targets’ are defined as blood pressure targets ≤ 140 to 160 mmHg systolic and/or blood pressure targets ≤ 90 to 100 mmHg diastolic. Our definition of CKD for this review is as follows: albuminuria (urine albumin excretion rate ≥ 30 mg per 24 hours, approximately equivalent to urine albumin:creatinine ratio ≥ 30 mg/g or ≥ 3 mg/mmol) as a marker of kidney damage and/or decreased GFR (GFR categories G3a to G5: GFR < 60 mL/min/1.73 m2). Kidney abnormalities defined in the studies as CKD will also be considered to fulfill our inclusion criteria, even though its presence during at least three months cannot be confirmed. Secondary objectives 1. To determine if there is a difference in mean achieved systolic and diastolic blood pressure associated with ’lower targets’ as compared with ’standard targets’ in people with CKD with elevated blood pressure. 2. To determine if there is a difference in frequency of withdrawals due to adverse effects with ’lower targets’ as compared with ’standard targets’ in people with CKD with elevated blood pressure. 3. To determine if there is a difference in the frequency of/rate of doubling of serum creatinine level or 50% reduction in GFR with ’lower targets’ as compared with ’standard targets’ in people with CKD with elevated blood pressure. 4. To determine if there is a difference in the proportion of participants reaching target levels of blood pressure between both approaches. 5. To determine if there is a difference in mean number of antihypertensive drugs used in the ’lower targets’ as compared with ’standard targets’ in people with CKD with elevated blood pressure.