An Editorial Update: What Level of Blood Pressure Control in Chronic Kidney Disease?

Chronic kidney disease affects about 11% of adults in the United States (1). Hypertension causes about 20% of new cases of kidney failure and complicates 60% to 80% of cases of chronic kidney disease caused by other disorders (2). Irrespective of the cause of chronic kidney disease, hypertension increases the risk for important adverse outcomes, such as progressive loss of kidney function and kidney failure, early development and accelerated progression of cardiovascular disease, and premature death. Angiotensin-converting enzyme (ACE) inhibitors are recommended in chronic kidney disease because in addition to lowering blood pressure, they reduce proteinuria, slow the decline of glomerular filtration rate, and delay the onset of kidney failure (3). However, we do not know the optimal level of blood pressure for slowing the progression of kidney disease. In March 2005, we published follow-up data from the Modification of Diet in Renal Disease (MDRD) Study that showed the long-term benefits of 2 years of a lower-than-usual blood pressure in nondiabetic kidney disease (4). At the same time, the Ramipril Efficacy in Nephropathy 2 (REIN-2) Trial suggested no benefit of lower blood pressure in nondiabetic kidney disease (5). The only other randomized, controlled trial of lower blood pressure in nondiabetic kidney disease was the African-American Study of Kidney Disease and Hypertension (AASK), published in 2002, which also showed no benefit (6). Here's our take on the REIN-2 Trial results and how they compare with the other 2 trials.