Reconciling Systolic Blood Pressure Intervention Trial With Eighth Joint National Commission

A Nuanced View of Optimal Hypertension Control in the Chronic Kidney Disease Population

Ekamol Tantisattamo; Anum Hamiduzzaman; Peter Sohn; Rebecca Ahdoot; Ramy M. Hanna


Curr Opin Nephrol Hypertens. 2022;31(1):57-62. 

In This Article

2021 Kidney Disease Improving Global Outcomes

The latest guidelines seeking to inform hypertension practice are the Kidney Disease Improving Global Outcomes (KDIGO) guidelines recently published in 2021.[29,30] The international group based on the International Society of Nephrology published their guidelines in Kidney International.[29,30] They concern a more holistic approach of the hypertensive patient including cardiovascular fitness as well as cognitive ability in addition to prescribing the need for a Dietary Approaches to Stop Hypertension diet.[29,30] An attempt to rule out white coat hypertension as well as a need to monitor home BPs are similarly prescribed to prior AHA/ACC, ESH/ECC,[27] and ISH guidelines. The 2021 KDIGO guidelines adhere more strongly to the SPRINT data and whereas they do not recommend SBP < 120 mmHg as a firm line for intervention, they do recommend 'monthly visits' until BP is under this target. DBP is similarly considered, and intervention is recommended at >100 mmHg to be immediately implemented and considered at BP > 90 mmHg. As such the 2021 KDIGO guidelines are the most stringent and SPRINT aligned[9] to date.[29,30] Table 1 summarizes the BP targets described in all the aforementioned BP guidelines issued by the major societies/regulatory bodies.