![]() The exact reasons for the differences in results are unknown but one possibility that has been hypothesized is the lower than expected event rate in ACCORD, resulting in decreased statistical power. In contrast to SPRINT, the Action to Control Cardiovascular Risk in Diabetes-Blood Pressure (ACCORD BP) trial found no reduction in cardiovascular mortality or non-fatal myocardial infarction and non-fatal stroke with similar blood pressure targets among patients with Type 2 diabetes mellitus (T2DM) 3. SPRINT enrolled 9361 non-diabetic patients and randomized them to a target systolic BP of < 120 mm Hg versus < 140 mm Hg, and found a 25% reduction in the primary composite outcome of cardiovascular mortality and cardiovascular morbidity among those randomized to the intensive blood pressure target (HR of 0.75, 95% CI 0.64, 0.89) 2. There have been recent updates in the recommendations regarding the BP target for the general population after publication of Systolic Blood Pressure Intervention Trial (SPRINT). We conclude with discussion of the limited clinical trials in this area.īlood Pressure Targets in the General Population We then discuss the prognostic importance of ambulatory blood pressure monitoring (ABPM) or home BP in comparison with in center BP measurements. In this review, we examine the observational data evaluating the relation between BP with CVD and mortality in dialysis patients and provide some interpretation of the differences in the relationships compared to the general population. Given that cardiovascular disease (CVD) is the leading cause of death among dialysis patients 1, addressing BP targets is however of paramount importance. However, the relationship between blood pressure and outcomes among dialysis patients is more complex and there are few trial data on blood pressure targets in this population. Clinical practice has relied on extrapolation of BP guidelines for the general population in whom hypertension is associated with greater cardiovascular mortality and morbidity, and in whom treatment of the hypertension leads to reduction in cardiovascular mortality. Up to 70–90% of dialysis patients carry a diagnosis of hypertension, and yet there are few data regarding the appropriate management of BP in this population. The management of blood pressure (BP) for patients with end stage kidney disease (ESKD) being treated with dialysis is challenging.
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