Blood Pressure Guidelines in Chronic Kidney Disease: A Critical Review

[okarol]

Vol. 113, No. 4, 2009  Free Access

Minireview - Clinical Guidelines

Blood Pressure Guidelines in Chronic Kidney Disease: A Critical Review
R.C. Thuraisingham, M.M. Yaqoob

Barts and the London NHS Trust and William Harvey Research Institute, London, UK

Address of Corresponding Author

Nephron Clin Pract 2009;113:c294-c300 (DOI: 10.1159/000235947)

 Outline

    * Key Words
    * Abstract
    * Guidelines
    * Blood Pressure Control Recommendations in CKD Guidelines
          o A Systolic Blood Pressure of <130 Is More Effective in Slowing the Progression of Diabetic and Non-Diabetic Kidney Disease with Proteinuria [4,5,6,7,8,9,10]
          o Target Blood Pressure for Cardiovascular Disease (CVD) Risk Reduction in CKD Should Be <130/80 mm Hg
          o Are Angiotensin-Converting Enzyme (ACE) Inhibitors and/or Angiotensin-II Receptor Blockers (ARBs) Better than Other Antihypertensive Agents in Slowing the Progression of Kidney Failure or CVD Risk Reduction in CKD Patients?
          o Implementation of Guidelines
          o Future Directions
    * References

    * Author Contacts
    * Article Information
    * Publication Details
    * Drug Dosage / Copyright

 goto top of outline Key Words

    * Guidelines
    * Standards
    * Progression of chronic kidney disease
    * Cardiovascular diseases

 goto top of outline Abstract

The primary purpose of guidelines should be to improve patient care by providing an avenue for healthcare professionals to participate in the assessment of appropriate care, based on sound medical reasoning and robust scientific knowledge. Guidelines are usually meant to be evidence-based when they are derived from systemic reviews of the relevant literature. Nephrology as a medical subspeciality lags behind other clinical disciplines when it comes to availability of high-quality clinical studies with hard clinical outcomes. In the absence of robust clinical evidence, recommendations in renal guidelines are overwhelmingly opinion-based and reflect the experience of the various experts. Unfortunately, no guidelines are detailed enough to provide recommendations for individual patients with different types and severity of co-morbidities. We propose that guidelines should be viewed as desirables and should not replace a common sense clinical approach to patient care by an autonomously practicing competent clinician.

Copyright © 2009 S. Karger AG, Basel

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