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Lower Blood Pressure May Help Sicker Kidney Patients

Standard goal may not be low enough for those with protein in their urine, study finds.

Aggressive treatment to lower high blood pressure may help preserve kidney function and prevent the need for dialysis in some black patients with chronic kidney disease.

That's the finding of a study published Sept. 2 in the New England Journal of Medicine.

"This is not a panacea. We have a lot more to figure out. But our evidence suggests that we have a way to at least delay or possibly even prevent end-stage kidney disease in some patients," study leader Dr. Lawrence J. Appel, a professor of medicine at Johns Hopkins University School of Medicine, said in a Hopkins news release.

The study of 1,094 black patients with chronic kidney disease and high blood pressure found that aggressive treatment to lower high blood pressure to about 130/80 provided the most benefit to sicker kidney disease patients -- those with protein in their urine.

In this group of patients, there was about a 25 percent reduction in end-stage kidney disease compared to those who achieved a blood pressure goal of 140/90, which is the standard of doctors when treating patients with high blood pressure.

Among patients who weren't as sick -- those with little or no protein in their urine -- efforts to lower blood pressure had little effect on kidney disease progression.

"This has always been a hot topic: Is a lower blood pressure goal better at preserving kidney function than the standard goal? The answer is a qualified yes, notably in people who have some protein in their urine," Appel said.

The findings suggest that doctors should check for protein in the urine before they determine the blood pressure goal for blacks with kidney disease, he added.

Blacks account for about one-third of patients with end-stage kidney disease in the United States, although they make up only 12 percent of the population.

Sources include:
http://www.hopkinsmedicine.org/news/media/releases/lower_blood_pressure_may_preserve_kidney_function_in_some_patients http://www.hopkinsmedicine.org/gim/faculty/appel.html
http://search.aafp.org/search?q=chronic+kidney+disease&site=a&client=aafp&proxystylesheet=aafp&filter=0&output=xml_no_dtd&getfields=*&hl=en&lr=lang_en&x=8&y=9 http://kidney.niddk.nih.gov/kudiseases/pubs/proteinuria/

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