Table 4. The chronology of the changes in guidelines.

ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; CKD: chronic kidney disease; BP: blood pressure

 

Year	Comorbidity	Changes made
2002	CKD	The recommended goal of antihypertensive therapy for patients at low or moderate risk for complications is to maintain systolic and diastolic BP less than 140- and 90-mm Hg, respectively.; Target BP is lower in younger patients and is related to age, weight, and height.; Target BP should be <130/85 mm hg for individuals with high blood pressure and decreased kidney function; In the general population, the recommended antihypertensive agents are diuretics and beta-adrenergic blockers. There should also be reduction in dietary salt and regular exercise; There is equal efficacy of ACEIs and calcium channel blockers in the general population
2002	Diabetic kidney disease or CKD stages 1-4 with proteinuria(>1g/dl); CKD stages 1-4 without proteinuria; CKD stage 5	Alternative target blood pressure and medications may be preferred in those subgroups of patients with comorbid conditions; In previous years, the target BP was 140/90 mmHg, especially in type one diabetes mellitus but BP of <125/75 has been recommended, alongside reduction in dietary salt; Use of ACEIs or ARBs and diuretics; For CKD stages 1-4 without proteinuria (<1 g/dl), Target BP is <135/85. There should also be a reduction in dietary salt intake and use of ACEI or ARBs; For CKD stage 5, Target BP is <140/50. There should be a reduction in dietary salt, fluid intake, and ultrafiltration in dialysis patients.
	Nondiabetic kidney diseases	No modifications were noted, although the NKF Task Force recommended target blood pressure levels and strategies for treatment for patients with CKD; ACEIs were recommended.
	Kidney transplant recipients	Use of calcium channel blockers for kidney transplant recipients.
2007 (Guideline 7)	CKD	Target BP for cardiovascular risk reduction should be <130/80 mmHg: Antihypertensives used depend on other underlying pathologies, if present.; Diuretics are also included in the regimen of most patients.
	Heart failure with diastolic dysfunction	Thiazide or loop diuretics; ACEIs or ARBs; aldosterone antagonists; beta-blockers.
	Post myocardial infarction with systolic dysfunction	ACEIs or ARBs; beta-blockers; aldosterone antagonists
	Post myocardial Infarction	Beta-blockers
	Recurrent stroke prevention	Thiazide or loop diuretics; ACEIs or ARBs
	Supraventricular tachycardia	Beta-blockers; calcium channel blockers
2004 (Guideline 8)	Diabetes in kidney disease	Target BP-<130/90 mmHg; Patients with or without hypertension should be treated with ACEIs or ARBs.
2004 (Guideline 9)	Nondiabetic kidney disease	Target BP -<130/90 mmHg •           Patients with or without hypertension should be treated with ACEIs or ARBs.
2004 (Guideline 10)	Kidney disease in the kidney transplant patient	Calcium channel blockers, diuretics, ACEIs, ARBs, beta-blockers
2004 (Guideline 11)	CKD	ACEIs and ARBs can be used safely in most patients with CKD; ACEIs and ARBs should be used in moderate to high doses, as used in clinical trials; They should be used as alternatives to each other if the preferred class cannot be used; They can be used in combination to lower BP or to reduce proteinuria;  Patients treated with ACEIs should be monitored for hypotension, decreased GFR, and hyperkalemia; ACEIs or ARBs can be continued if GFR decline over four months is <30% from the baseline and/or serum potassium level is = 5.5 mEq/L
2005	CKD (hypertension control in the dialysis patient)	Pre-dialysis BP goals- <140/90 mmHg; Post dialysis BP goals- <130/80 mmHg.; Use of renin-angiotensin inhibitors such as ACEIs or ARBs
	BP control in children	Optimal systolic and diastolic BP should be < 95% for age, gender and height; Management of BP pays attention here to fluid status and antihypertensive medications and minimizing intradialytic fluid accumulation; Education by dieticians every three months; Low salt intake; Longer dialysis ultrafiltration
2007	Diabetes and CKD (stages 1-4)	Target BP in diabetes and CKD stages 1-4 should be <130/80mmhg; Hypertensive people with diabetes and CKD stages 1-4 should be treated with an ACEI or an ARB, usually in combination with a diuretic(preferred); then a beta-blocker or calcium channel blocker.
2012	CKD (in relation to age, nondiabetic kidney disease, diabetic kidney disease, kidney transplant recipients	For patients with CKD with normal to mildly increased albuminuria, goal BP has been relaxed to =140/90 mm hg for both diabetic and nondiabetic patients.. However, target BP for patients with CKD with moderately or severely increased albuminuria and all renal transplant patients with/without the presence of proteinuria should be = 130/80 mmHg.
	Age	For BP control in the elderly, a BP goal of <140/90 mmHg is acceptable, and the choices are not mandated In adults with diabetes in CKD, and with mild albuminuria, they should be maintained at a bp of < or =140 mmHg, and a diastolic of < or =90 mmHg. In adults with diabetes in CKD, and with moderate to severe albuminuria, they should be maintained at a bp of < or =130 mmHg, and a diastolic of < or =80 mmHg