Optimal Targets for Blood Pressure Control in CKD

Future Studies

It could be argued that we already have enough syntheses, opinions, guidelines and advice for the time being, what we need is more data.

Two promising investigations are already underway. The first is the NIH-supported SPRINT study which will randomize over 7500 patients to systolic BP targets of 140 mmHg or 120 mmHg, and will include 1750 patients over 75, with 9-year follow-up of cardiovascular, cognitive and kidney end points. This trial has deliberately oversampled people with CKD, and this should thus help us to better understand optimal approaches in nondiabetic CKD. Secondly, a number of trials are in process which will randomize blinded haemodialysis patients to spironolactone or placebo to test the striking observations of Matsumoto et al. in Shizuoka with a more rigorous methodology.

Here are some suggestions for other studies, including some proposed by the KDIGO authors:

1. 
   studies which examine the impact of lifestyle interventions, exercise and comorbidities, particularly cognitive impairment;
   
2. 
   randomization of CKD patients to risk-based vs. target-based BP interventions;
   
3. 
   age-specific studies, particularly in the elderly;
   
4. 
   usual care vs. Kaiser Permanente style polypill with support in CKD stages 3 to 4;
   
5. 
   intensive drug-based BP management vs. longer dialysis in haemodialysis patients.