Blood Pressure Management
Well controlled blood pressure has been shown to slow progression of kidney disease, reduce cardiovascular events, and reduce mortality.
Aim for blood pressure targets based on urine ACR:
| Urine ACR (mg/mmol) | Clinic Blood pressure target (mmHg) | Home Blood pressure target (mmHg) |
|---|---|---|
| < 70 | < 140/90 | <135/85 |
| > 70 | < 130/80 | < 125/75 |
| Age > 80 years | < 150/90 | <145/85 |
* Individualise target based on age and frailty.
All patients with CKD should be advised to minimise dietary salt. This will improve blood pressure control, fluid retention and can also slow down progression of their CKD.
Patients with CKD may need several anti-hypertensive agents to achieve good blood pressure control in addition to lifestyle measures. Those with diabetic kidney disease or significant proteinuria (ACR >30 mg/mmol) in particular benefit from blockade of the renin-angiotensin system (RAS) with ACE (angiotensin converting enzyme) inhibitors or ARBs (angiotensin receptor blockers). These are therefore often the best first choice anti-hypertensive agent in these patient groups (see the RAS inhibitor section).
Referral criteria: Patient with poorly controlled BP despite the use of 4 agents should be referred to a specialist for further evaluation (see the referral to specialists section).