KDIGO updates 2012 guideline on managing blood pressure in CKD, largely informed by SPRINT
Kidney Disease: Improving Global Outcomes has revised its guideline on managing blood pressure in patients with chronic kidney disease. The guideline was originally published in 2012.
“Since then, completion of the Systolic Blood Pressure Intervention Trial (SPRINT) sponsored by the National Institutes of Health along with several related meta-analyses and the revision of BP guidelines by many guideline task forces around the world prompted the re-examination of the KDIGO guideline on BP,” the organization wrote in an executive summary, noting the guideline is still specific to patients with CKD not receiving dialysis as “the definition, management, and nuances of high BP” are vastly different between the two patient populations.
According to a press release, the three primary areas covered in the update include: techniques for blood pressure measurement, lifestyle interventions for lowering blood pressure and distinct recommendations for blood pressure management in adults and children, as well as kidney transplant recipients.
Chapter one provides a new addition to the 2012 guideline and focuses on utilizing standardized blood pressure measurements as opposed to routine ones.
“Standardized office BP refers to measurements obtained using recommended preparations and measurement techniques, regardless of the type of equipment used,” the organization wrote. “ ... In contrast, routine office BP refers to measurements obtained without using these preparations and is often called casual office BP ... The BP target cannot be applied if routine BP values are obtained, because large randomized trials that examined target BP, such as SPRINT, employed standardized BP.”
In the press release, Johannes Mann, MD, a co-chair for the guideline, emphasized the need for practice changes regarding blood pressure measurement.
“There is a renewed appreciation for proper BP measurement techniques and their relationships to appropriate targets, so it is our hope that this guideline has identified opportunities for improving blood pressure care with the ultimate goal to reduce cardiovascular and kidney disease risks among persons with CKD not on dialysis,” he said.
The optimal target, according to KDIGO, is a systolic blood pressure less than 120 mm/Hg, which is lower than that recommended in 2012 (less than 130 mm/Hg). This change is largely due to the “cardioprotective, survival, and potential cognitive benefits as shown in the SPRINT trial,” the organization wrote.
Regarding interventions, KDIGO recommended patients with CKD reduce dietary salt intake and engage in more physical activity. Though other lifestyle interventions, including weight loss and reduction of alcohol consumption, have shown associations with lower blood pressure in the general population, KDIGO noted a lack of data specific to the CKD population “precludes” these recommendations from being in the guideline.
“We are excited to share this guideline with the global nephrology and general medical communities,” Alfred K. Cheung, MD, co-chair of the guideline, said in the release. “This update reflects the new research emerged since 2012 which allows us to examine the current evidence base and revise previous guidance on blood pressure management issues that many CKD patients face on a daily basis.”