187
Table 12.1
Target blood pressure (BP) in chronic kidney disease and definition of resistant hypertension
Target BP in chronic kidney disease
Target BP in chronic kidney disease with pathological albuminuria/proteinuria
Target BP in elderly persons
Definition of resistant hypertension
KDIGO
≤
140/90
≤
130/80
No specific targets
n. a.
CHEP
<140/90 in nondiabetic<130/80 in DM
As in chronic kidney disease
Age
≥
80 years:
Systolic BP <150
b
n. a.
JNC 8
<140/90
As in chronic kidney disease
Age
≥
60 years:
<140/90 if DM and/or chronic kidney disease
n. a.
JNC 7
<130/80
As in chronic kidney disease
No specific targets
Failure to achieve goal BP in patients who are adhering to full doses of an appropriate three-drug regimen that includes a diuretic
ISH/ASH
<140/90
As in chronic kidney disease
a
Age
≥
80 years:
<140/90 if DM and/or chronic kidney disease
BP
≥
140/90 mmHg with use of three drugs
(ACEi or ARB/CCB/diuretic) in full or maximally tolerated doses
NICE
<140/90 in nondiabetic<130/80 in DM
<130/80
Age
≥
80 years:
<150/90
b
BP >140/90 mmHg after treatment with the optimal or best tolerated doses of an ACE inhibitor or an ARB plus a CCB plus a diuretic
NHFA
<130/80
<125/75
No specific targets
n. a.
ESC/ESH
Systolic BP <140
Systolic BP <130
Age
≥
80 years:
<150/90
b
BP
≥
140/90 mmHg with appropriate lifestyle
measures and three drugs (a diuretic and two other drugs belonging to different classes, not necessarily including a MRA) at adequate doses
Adapted from [
6 ]; with permission. BP expressed in mmHg
n. a.
not addressed,
BP
blood pressure,
DM
diabetes mellitus,
ACE
angiotensin-converting enzyme,
ARB
angiotensin receptor blocker,
CCB
calcium channel
blocker,
MRA
mineralocorticoid receptor antagonist
Note that BP targets apply to seated office BP measurementsaISH/ASH generally recommend a < 140/90 mmHg BP target for chronic kidney disease but acknowledge that “some experts still recommend less than 130/80 mmHg” in albuminuriabNo specific recommendations are given for elderly persons with chronic kidney disease and/or DM
12 Resistant Hypertension in Elderly People with Chronic Kidney Disease