Lower blood pressure could prove to be dangerous to patients with chronic kidney disease, an expert declares.
Recent guidelines by The National Kidney Foundation Disease Outcomes Quality Initiative (NKF KDOQI) call for lower target blood pressure levels in patients with CKD.
But in the absence of high-quality scientific evidence, there's a chance this recommendation could do more harm than good, according to Julia B. Lewis, MD (Vanderbilt University, Nashville, TN), who performed a critical review of the research evidence.
"The new low blood pressure goals are not definitively supported by data, would be costly to the healthcare system and potentially harmful to patients," she says.
Issued last year, updated national guidelines for CKD treatment call for a target blood pressure level of less than 130/80 mm Hg (millimeters of mercury) to help preserve kidney function. The recommendation was based on observational studies showing "a continuous benefit of reducing blood pressure to lower and lower levels."
However, Lewis points out several problems with the research behind the new guidelines. Most importantly, since patients in the observational studies were not randomly assigned to different blood pressure goals, the apparent benefit of lower blood pressures could result from other "confounding" factors.
"The data supporting the current blood pressure guidelines for patients with CKD do not meet the standard of a primary outcome of a randomized trial," says Lewis.
She explains that, as kidney disease worsens, blood pressure rises and becomes harder to control. So the data may simply reflect the fact that patients with less severe kidney disease have lower blood pressure.
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