ONTARGET still OFF-TARGET?

Heerspink, Hiddo J L; Zeeuw, Dick de

doi:10.1161/circulationaha.111.018382

Cited by 11 publications

(2 citation statements)

References 22 publications

(13 reference statements)

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“…Thus, the ONTARGET trial did not demonstrate any cardiovascular benefit for dual RAAS blockade (with the ACEI Ramipril and the ARB Telmisartan), in a population at high risk of CVD, but did suggest an increased risk of major renal outcomes. Lambers Heerspink and de Zeeuw [23] suggested that the unanticipated results may have been because of the patient population studied, and that the result might have been different if the population had included a greater number of patients with CKD than the 13% with albuminuria. A parallel group of 5927 potential ONTARGET participants with known cardiovascular disease or diabetes with end-organ damage but without macroalbuminuria or heart failure who could not tolerate ACEIs were treated with Telmisartan, 80 mg/day ( n =2954), or matching placebo ( n = 2972) plus standard treatment and followed for over 4.7 years [24].…”

Section: Key Treatment Trials Of Hypertensive Chronic Kidney Diseasementioning

confidence: 99%

What should be the blood pressure target for patients with chronic kidney disease?

Nicholas

Vaziri²,

Norris³

2013

Current Opinion in Cardiology

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Purpose of review Persons with chronic kidney disease (CKD) exhibit a disproportionate burden of elevated blood pressure (BP) with a high prevalence of premature end-stage renal disease and cardiovascular events. Recent findings Results of recent randomized controlled clinical trials suggest that most patients with reduced estimated glomerular filtration rate (eGFR) and hypertension experience optimal clinical outcomes when SBP is less than 140 mmHg and DBP is less than 90 mmHg. The benefit of additional lowering of SBP to less than 130 mmHg and DBP to less than 80 mmHg remains controversial, and appears to be of most benefit to the subset of CKD patients with proteinuria (>300 mg/day). The combination of a diuretic and an angiotensin receptor blocker (ARB) or angiotensin-converting enzyme inhibitor (ACEI) has demonstrated particular promise in patients with reduced eGFR and proteinuria. Summary A practical approach in clinical practice for the treatment of elevated BP in persons with CKD is to achieve a BP less than 140/90 mmHg with a combination of diuretic and an ARB or ACEI. Consideration for a lower BP goal and other therapeutic and nontherapeutic interventions can be made based on the cause of CKD, presence of proteinuria, or other coexisting medical conditions.

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Section: Key Treatment Trials Of Hypertensive Chronic Kidney Diseasementioning

confidence: 99%

What should be the blood pressure target for patients with chronic kidney disease?

Nicholas

Vaziri²,

Norris³

2013

Current Opinion in Cardiology

View full text Add to dashboard Cite

show abstract

“…281 This finding has been questioned for a range of reasons, and it has been suggested that the result may have been different if the population included a greater number of patients with CKD. 425 …”

Section: 4: Should Raas Inhibition Be Maximized In Ckd Patients?mentioning

confidence: 99%