History and Evolution of Hypertension Goals in Patients with Chronic Kidney Disease

Blaise W Abramovitz; Alavi Hossain; Rushelle Byfield; Jordana B Cohen

doi:10.1016/j.ccl.2025.03.003

History and Evolution of Hypertension Goals in Patients with Chronic Kidney Disease

Cardiol Clin. 2025 Aug;43(3):491-498. doi: 10.1016/j.ccl.2025.03.003. Epub 2025 Apr 28.

Authors

Blaise W Abramovitz¹, Alavi Hossain², Rushelle Byfield³, Jordana B Cohen⁴

Affiliations

¹ Division of Renal-Electrolyte, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
² Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³ Division of Nephrology, Department of Pediatrics, Columbia University, New York, NY, USA.
⁴ Renal-Electrolyte and Hypertension Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: jco@pennmedicine.upenn.edu.

PMID: 40582740
DOI: 10.1016/j.ccl.2025.03.003

Abstract

Optimal blood pressure targets for patients with chronic kidney disease (CKD) remain a subject of ongoing debate. This review explores the evolution of evidence guiding blood pressure treatment thresholds in patients with CKD, highlighting shifts from kidney-focused outcomes to cardiovascular benefits. We examine landmark trials, historical and current guideline recommendations, and key controversies surrounding intensive blood pressure control. Additionally, we discuss challenges in applying existing data to underrepresented CKD populations. By synthesizing current evidence, this review aims to provide a comprehensive perspective on individualized blood pressure goals for patients with CKD.

Keywords: Antihypertensive medication; Blood pressure; Cardiovascular risk; Chronic kidney disease; Hypertension.

Publication types

Review

MeSH terms

Antihypertensive Agents* / therapeutic use
Blood Pressure* / drug effects
Blood Pressure* / physiology
Humans
Hypertension* / complications
Hypertension* / drug therapy
Hypertension* / physiopathology
Practice Guidelines as Topic
Renal Insufficiency, Chronic* / complications
Renal Insufficiency, Chronic* / physiopathology

Substances

Antihypertensive Agents