Table 1.
2012 KDIGO, 2021 KDIGO, and 2017 ACC/AHA blood pressure guideline recommendations for blood pressure goals and use of renin angiotensin aldosterone system inhibitors (ACEi or ARB)
| Recommendation | 2012 KDIGO | 2021 KDIGO | 2017 ACC/AHA |
|---|---|---|---|
| Blood pressure goals* | |||
| No albuminuria (A1) | SBP ≤140 mm Hg and DBP ≤90 mm Hg (1B) | SBP <120 mm Hg, when tolerated, using standardized office BP measurement (2B) | SBP <130 mm Hg and DBP < 80 mm Hg for all adults with CKD |
| Albuminuria (A2, A3),† No diabetes | SBP ≤130 mm Hg and DBP ≤80 mm Hg (A2: 2D, A3: 2C) | ||
| Albuminuria (A2, A3),† Diabetes | SBP ≤130 mm Hg and DBP ≤80 mm Hg (2D) | ||
| RASi (ACEi/ARB) use | |||
| No albuminuria (A1) | — | — | Treatment with ACEi (or ARB if not tolerated) may be reasonable in those with hypertension∥ and eGFR<60 ml/min/1.73m2 or eGFR ≥60 ml/min/1.73m2 with ACR ≥300 mg/g |
| Albuminuria (A2, A3),† No diabetes | Suggest (A2: 2D)/Recommend (A3: 1B) RASi when BP-lowering drugs are indicated‡ | Suggest (A2: 2C)/ Recommend (A3: 1B) starting RASi for those with high BP§ | |
| Albuminuria (A2, A3),† Diabetes | Suggest (A2: 2D)/Recommend (A3: 1B) RASi when BP-lowering drugs are indicated‡ | Recommend (A2, A3) RASi for people with high BP§ (1B) | |
Abbreviations: KDIGO, Kidney Disease: Improving Global Outcomes. ACC, American College of Cardiology. AHA, American Heart Association. RASi, Renin angiotensin aldosterone system inhibitors [defined as angiotensin-converting enzyme inhibitors (ACEi) or Angiotensin II-receptor blockers (ARB)]. SBP, systolic blood pressure. DBP, diastolic blood pressure. BP, blood pressure. CKD, chronic kidney disease. eGFr, estimated glomerular filtration rate.
Evidence grading: Level 1 “We recommend,” Level 2 “We suggest.” Quality of evidence: A “High,”, B “Moderate,” C “Low,” D “Very low.”
Recommend those whose blood pressure is consistently above the goal be treated with blood pressure-lowering drugs to maintain a blood pressure that is consistently below the goal
Albuminuria defined as albumin-to-creatinine ratio (ACR) ≥30 mg/g. A2: ACR 30–300 mg/g. A3: ACR>300 mg/g
BP above the goal of SBP ≤130 mm Hg and DBP ≤80 mm Hg for those with albuminuria
Blood pressure above the goal of SBP <120 mm Hg
Blood pressure above the goal of SBP <130 mm Hg and DBP <80 mmHg