Debate: PRO position. People with chronic kidney disease should have a blood pressure lower than 130/80 mm Hg

The optimal BP for adults to preserve and maintain optimal cardiovascular health is not known. Treatment of hypertension according to current definitions by the JNC VII committee is strongly advised. Evidence from both observational studies and clinical trials supports a systolic BP goal of < 130 mm Hg for preserving renal function and reducing cardiovascular morbidity in those with kidney disease and diabetes. Still, there are no largescale rigorously designed and conducted randomized controlled trials in patients with kidney disease aimed at directly comparing the effect of more aggressive versus less aggressive systolic BP targets on renal and cardiovascular outcomes. The ACCORD trial in patients with type 2 diabetes did not show overall beneficial effects of more aggressive BP lowering on cardiovascular outcomes, although the stroke rate was significantly reduced by this therapy. The Systolic Pressure Intervention Trial (SPRINT) is a novel large-scale trial in the development process. It will examine whether more versus less aggressive systolic BP control will improve cardiovascular and renal outcomes in a large cohort of nondiabetics in the United States. This trial will include a large proportion of patients with CKD and it should provide important new evidence on the optimal BP goal and how to achieve such a goal in this patient population.