What is the ideal blood pressure goal for patients with stage III or higher chronic kidney disease?

Hypertension and chronic kidney disease (CKD) are public health problems well known to the national and international medical communities. Blood pressure (BP) control in patients with CKD stage III and IV plays a key factor in reducing cardiovascular risk and renal disease progression. We conducted a literature review of recent studies addressing BP targets and cardiorenal outcomes in patients with CKD. Multiple studies demonstrated cardiovascular benefits associated with greater BP reduction. Nevertheless, a U-shaped relationship between BP, cardiovascular events, and renal function was present. In patients with CKD stage III and IV, a BP less than 140/90 mm Hg appeared to be a reasonable target. Moreover, in patients with CKD and proteinuria of more than 1 g/day, a target systolic BP of 120 to 130 mm Hg and diastolic BP of 70 to 80 mm Hg yielded the greatest benefit while avoiding most of the adverse cardiovascular outcomes associated with lower levels of BP.