The chaos of hypertension guidelines for chronic kidney disease patients

Castillo-Rodríguez, Esmeralda; Fernández-Fernández, Beatriz; Alegre-Bellassai, Raquel; Kanbay, Mehmet; Ortíz, Alberto

doi:10.1093/ckj/sfz126

Cited by 13 publications

(13 citation statements)

References 11 publications

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“…As already discussed, the optimal office BP threshold to diagnose hypertension and the relevant BP target in patients with CKD is currently still unclear, with different existing recommendations from major societies creating a confusing environment for the average practicing nephrologist [15]. This “chaos” of recommendations could be attributed to several reasons, including the absence of relevant evidence for specific types of CKD patients (such as those with diabetes), contrasting results during the randomized periods and the long-term observational extensions of the few trials in the field, and the possibility that different BP targets have different effects on cardiovascular and renal outcomes [15, 25-27]. With regard to KTRs, no specific guidance on these issues was offered by previous recommendation documents, probably due to the complete absence of evidence in this population.…”

Section: Discussionmentioning

confidence: 99%

“…The optimal office BP threshold to diagnose hypertension and the relevant target in patients with CKD in general, as well as KTRs in particular is still a matter of intense debate [15]. In 2014, the Joint National Committee (JNC) 8 guidelines suggested a BP threshold of 140/90 and a target of <140/90 mm Hg for patients with CKD [16], while currently, there is a discrepancy between the 2018 European Society of Hypertension/European Society of Cardiology (ESH/ESC) guidelines [17] suggesting a threshold of 140/90 mm Hg and a systolic blood pressure (SBP) target between 130 and 139 mm Hg, and the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines [18] that introduced a BP threshold of 130/80 mm Hg in all patients, including those with CKD.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Performance of Office versus Ambulatory Blood Pressure in Kidney Transplant Recipients

et al. 2021

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Introduction: Hypertension is the most prominent risk factor in kidney transplant recipients (KTRs). No study so far assessed in parallel the prevalence, control, and phenotypes of blood pressure (BP) or the accuracy of currently recommended office BP diagnostic thresholds in diagnosing elevated ambulatory BP in KTRs. Methods: 205 stable KTRs underwent office BP measurements and 24-h ambulatory BP monitoring (ABPM). Hypertension was defined as follows: (1) office BP ≥140/90 mm Hg or use of antihypertensive agents following the current European Society of Cardiology/European Society of Hypertension (ESC/ESH) guidelines, (2) office BP ≥130/80 mm Hg or use of antihypertensive agents following the current American College of Cardiology/American Heart Association (ACC/AHA) guidelines, (3) ABPM ≥130/80 mm Hg or use of antihypertensive agents, and (4) ABPM ≥125/75 mm Hg or use of antihypertensive agents. Results: Hypertension prevalence by office BP was 88.3% with ESC/ESH and 92.7% with ACC/AHA definitions compared to 94.1 and 98.5% at relevant ABPM thresholds. Control rates among hypertensive patients were 69.6 and 43.7% with office BP compared to 38.3 and 21.3% with ABPM, respectively. Both for prevalence (κ-statistics = 0.52, p < 0.001 and 0.32, and p < 0.001) and control rates (κ-statistics = 0.21, p < 0.001 and 0.22, and p < 0.001, respectively), there was moderate or fair agreement of the 2 techniques. White-coat and masked hypertension were diagnosed in 6.7 and 39.5% of patients at the 140/90 threshold and 5.9 and 31.7% of patients at the 130/80 threshold. An office BP ≥140/90 mm Hg had 35.3% sensitivity and 84.9% specificity for the diagnosis of 24-h BP ≥130/80 mm Hg. An office BP ≥130/80 mm Hg had 59.7% sensitivity and 73.9% specificity for the diagnosis of 24-h BP ≥125/75 mm Hg. Receiver operating curve analyses confirmed this poor diagnostic performance. Conclusions: At both corresponding thresholds studied, ABPM revealed particularly high hypertension prevalence and poor BP control in KTRs. Misclassification of KTRs by office BP is substantial, due to particularly high rates of masked hypertension. The diagnostic accuracy of office BP for identifying elevated ambulatory BP is poor. These findings call for a wider use of ABPM in KTRs.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnostic Performance of Office versus Ambulatory Blood Pressure in Kidney Transplant Recipients

et al. 2021

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“…Somit muss sie immer ergänzend zur Praxis-Blutdruckmessung durchgeführt werden [4]. Die aktuell allgemeingültigen Zielwerte in der Langzeit-Blutdruckmessung sind: Durchschnittswert Gesamt < 130/80 mmHg, Tagesdurchschnitt < 135/85 mmHg und Nachtdurchschnitt < 120/70 mmHg [9]. Es gibt keine Daten, die dafürsprechen, dass die Blutdruckziele in der Langzeit-Blutdruckmessung für die CNI-Patienten anders als für die Allgemeinbevölkerung sind.…”

Section: Langzeit-blutdruckmessungunclassified

Die Bedeutung der Langzeit-Blutdruckmessung bei Patienten mit Nierenkrankheiten

Reshetnik

2021

Dialyse aktuell

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ZUSAMMENFASSUNGDie arterielle Hypertonie (aHTN) ist einer der führenden Ursachen für die Progression der chronischen Niereninsuffizienz (CNI). Die Prävalenz der aHTN in der CNI-Population ist sehr hoch und mit einem erhöhten kardiovaskulären Risiko assoziiert. Eine verlässliche Messung der Blutdruckwerte ist für die Blutdruckeinstellung und Therapie essenziell. Der additive Nutzen der Langzeit-Blutdruckmessung liegt in der besseren Abbildung der Blutdruckwerte über längere Zeit (i. d. R. 24 Stunden) und damit in der besseren Detektion der Weißkittel-, maskierten oder nächtlichen Hypertonie. Zudem zeigen Durchschnitts-Blutdruckwerte aus der Langzeitmessung in der CNI-Population eine bessere Korrelation zu kardiovaskulären und renalen Ereignissen als die Werte aus der Praxis-Blutdruckmessung. Da bislang alle randomisierten Interventionsstudien als Zielwerte des Praxis-Blutdruckes verwendet haben, kann die Langzeitmessung nicht alleine zur Therapieüberwachung verwendet werden.

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“…Some relevant examples relate to well-established CVD risk factors, such as hypertension and dyslipidaemia. Regarding hypertension, the 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease; the 2017 American College of Cardiology/American Heart Association Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults; and the 2018 European Society of Cardiology, European Society of Hypertension Guidelines for the Management of Arterial Hypertension refer to different CKD populations and propose different definitions of hypertension, different thresholds to initiate anti-hypertensive therapy in CKD patients and different blood pressure targets for drug-treated hypertension [ 6 ]. Consensus documents have tried to fill the void left by evidence-based medicine [ 7–9 ].…”

Section: Cardiovascular Disease In Chronic Kidney Diseasementioning

confidence: 99%

Pelacarsen for lowering lipoprotein(a): implications for patients with chronic kidney disease

Fernández-Prado

Perez-Gomez

Ortíz

2020

Clinical Kidney Journal

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Chronic kidney disease (CKD) patients are at an increased risk of cardiovascular disease (CVD) and statins may not be protective in advanced CKD. The reasons for the limited efficacy of statins in advanced CKD are unclear, but statins may increase plasma levels of the highly atherogenic molecule lipoprotein(a), also termed Lp(a), as well as PCSK9 (protein convertase subtilisin/kexin type 9) levels. Lp(a) has also been linked to calcific aortic stenosis, which is common in CKD. Moreover, circulating Lp(a) levels increase in nephrotic syndrome with declining renal function and are highest in patients on peritoneal dialysis. Thus, the recent publication of the Phase 2 randomized controlled trial of pelacarsen [also termed AKCEA-APO(a)-LRx and TQJ230], a hepatocyte-directed antisense oligonucleotide targeting the LPA gene messenger RNA, in persons with CVD should be good news for nephrologists. Pelacarsen safely and dose-dependently decreased Lp(a) levels by 35–80% and a Phase 3 trial [Lp(a)HORIZON, NCT04023552] is planned to run from 2020 to 2024. Unfortunately, patients with estimated glomerular filtration rate <60 mL/min or urinary albumin:creatinine ratio >100 mg/g were excluded from Phase 2 trials and those with ‘significant kidney disease’ will be excluded from the Phase 3 trial. Optimized exclusion criteria for Lp(a)HORIZON would provide insights into the role of Lp(a) in CVD in CKD patients.

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The chaos of hypertension guidelines for chronic kidney disease patients

Cited by 13 publications

References 11 publications

Diagnostic Performance of Office versus Ambulatory Blood Pressure in Kidney Transplant Recipients

Diagnostic Performance of Office versus Ambulatory Blood Pressure in Kidney Transplant Recipients

Die Bedeutung der Langzeit-Blutdruckmessung bei Patienten mit Nierenkrankheiten

Pelacarsen for lowering lipoprotein(a): implications for patients with chronic kidney disease

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