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2021 KDIGO Guideline Lowers Target Systolic BP for Adults With CKD

MONDAY, March 15, 2021 -- The 2021 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for management of blood pressure in patients with chronic kidney disease (CKD) increase eligibility for blood pressure lowering, according to a study published in the March 1 issue of Kidney International.

Kathryn E. Foti, Ph.D., from the John Hopkins Bloomberg School of Public Health in Baltimore, and colleagues examined the potential implications of the 2021 KDIGO guidelines, recommending a target systolic blood pressure of less than 120 mm Hg, for blood pressure lowering with antihypertensive medication among adults with CKD compared with the 2012 KDIGO guideline and the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline. Implications of the guideline on the use of angiotensin-converting enzyme inhibitors (ACEi) or angiotensin II receptor blockers (ARB) for those with albuminuria were also examined. Data were analyzed for 1,699 adults with CKD in the 2015 to 2018 National Health and Nutrition Examination Survey.

The researchers found that 69.5 percent of adults with CKD were eligible for blood pressure lowering according to the 2021 KDIGO guideline, compared with 49.8 or 55.6 percent as per the 2012 KDIGO guideline and 2017 ACC/AHA guideline, respectively. According to the 2021 KDIGO guidelines, 78.2 percent with albuminuria were eligible for ACEi/ARB compared with 71 percent according to the 2012 KDIGO guidelines; 39.1 percent were taking ACEi/ARB.

"This is a major update of an influential set of guidelines for chronic kidney disease patients, and it is coming out against a backdrop of worsening blood pressure control in the U.S.," Foti said in a statement.

Several authors disclosed financial ties to the pharmaceutical industry.

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