There is strong evidence that lower than usual targets are beneficial in renal diseases, but especially in those associated with significant proteinuria. Any limits set are arbitrary, but for example, the current SIGN and NICE guideline levels are:
ACE inhibitors or ARBs should be included in:
|
The previous UK CKD guidelines and some US guidance recommended slightly lower targets, and some nephrologists favour these:
|
ACE inhibitors are proven to be particularly effective at protecting renal function in patients with proteinuria. A2R antagonists are likely to be equally effective. Non-dihydropyridine calcium antagonists (verapamil, diltiazem) have some theoretical (not proven) advantage if patients cannot tolerate ACEI or A2R blockade.
Blood pressure targets should be individualised, as patients have different circumstances. For example, patients of black race should possibly have lower targets as the risk of end organ damage is greater. Very young patients may merit lower targets.
It is sometimes useful to consider average blood pressure at different ages – although it must be noted that there is no evidence to support using these as therapeutic targets.
Age |
18-24 |
25-34 |
35-44 |
45-54 |
55-64 |
65-74 |
Systolic
|
125 |
128 |
128 |
134 |
141 |
145 |
Diastolic
|
62 |
69 |
74 |
79 |
80 |
78 |
Systolic
|
117 |
117 |
121 |
130 |
139 |
149 |
Diastolic
|
62 |
66 |
70 |
73 |
74 |
73 |
Blood pressure and proteinuria
Lowering blood pressure can reduce proteinuria. ACE inhibitors and ARBs achieve greater lowering of proteinuria than other first-line hypotensive agents.
Other proteinuria-reducing strategies are mentioned on the proteinuria page.