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(Hypertension. 1997;29:641-650.)
© 1997 American Heart Association, Inc.
Articles |
Achievement and Safety of a Low Blood Pressure Goal in Chronic Renal Disease
The Modification of Diet in Renal Disease Study Group*
the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Md. The institutions and investigators who participated in the study are listed in Reference 20.
Correspondence to Gerald Beck, PhD, MDRD Data Coordinating Center, Department of Biostatistics and Epidemiology, P88, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail gbeck@bio.ri.ccf.org
The Modification of Diet in Renal Disease Study showed a beneficial effect of a lower-than-usual blood pressure (BP) goal on the progression of renal disease in patients with proteinuria. The purpose of the present analyses was to examine the achieved BP, baseline characteristics that helped or hindered achievement of the BP goals, and safety of the BP interventions. Five hundred eighty-five patients with baseline glomerular filtration rate between 13 and 55 mL/min per 1.73 m2 (0.22 to 0.92 mL/s per 1.73 m2) were randomly assigned to either a usual or low BP goal (mean arterial pressure 
107 or 92 mm Hg, respectively). Few patients had a history of cardiovascular disease. All antihypertensive agents were permitted, but angiotensin-converting enzyme inhibitors (with or without diuretics) followed by calcium channel blockers were preferred. The mean (±SD) of the mean arterial pressures during follow-up in the low and usual BP groups was 93.0±7.3 and 97.7±7.7 mm Hg, respectively. Follow-up BP was significantly higher in subgroups of patients with preexisting hypertension, baseline mean arterial pressure >92 mm Hg, a diagnosis of polycystic kidney disease or glomerular diseases, baseline urinary protein excretion >1 g/d, age 
61 years, and black race. The frequency of medication changes and incidence of symptoms of low BP were greater in the low BP group, but there were no significant differences between BP groups in stop points, hospitalizations, or death. When data from both groups were combined, each 1–mm Hg increase in follow-up systolic BP was associated with a 1.35-times greater risk of hospitalization for cardiovascular or cerebrovascular disease. Lower BP than usually recommended for the prevention of cardiovascular disease is achievable by several medication regimens without serious adverse effects in patients with chronic renal disease without cardiovascular disease. For patients with urinary protein excretion >1 g/d, target BP should be a mean arterial pressure of 92 mm Hg, equivalent to 125/75 mm Hg.
Key Words: drugs, antihypertensive • blood pressure • renal disease • safety
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