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.

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.

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Table 1. Summarized blood pressure target from the landmark trials and different scientific societies
Study/Guideline	Blood pressure goals (mmHg)
SPRINT	SBP < 120
STEP	SBP < 110–130
JNC-8	Normal SBP < 120 Pre hypertension 120–139/DBP < 80 Stage I hypertension 140–159/< 90 Stage II hypertension 160/100Elderly patients BP < 150/90
ACC/AHA	Normal BP < 120 Prehypertension 121–129/< 80 Stage I hypertension 130–139/80–89 (lower than JNC-8) treatment decided by CVD risk Stage II hypertension >140/90 BP routine pharmacotherapy
ESH/ECC	Normal <130/80 Prehypertension group 130–139/85–89 Pharmacotherapy based on CVD risk Low-risk hypertension group >140–159/90 Can stratify to treat with pharmacotherapy by CVD risk High risk hypertension >160/90 always needs pharmacotherapy
ISH	Normal <140/90 Grade I hypertension 140–159/90–99 Grade II hypertension >159/99
KDIGO 2021	SBP goal <120, otherwise require treatment

ACC/AHA, American College of Cardiology/American Heart Association; BP, blood pressure; DBP, diastolic blood pressure; ESH/ECC, European Society of Hypertension/European College of Cardiology; ISH, International Society of Hypertension; JNC-8, Joint National Conference on Hypertension (eighth); KDIGO, Kidney Disease Improving Global Outcomes; SBP, systolic blood pressure; SPRINT, Systolic Blood Pressure Intervention; STEP, Strategy of Blood Pressure Intervention in Elderly Hypertensive Patients.