What is the target blood pressure for a 55-year-old patient with Chronic Kidney Disease (CKD) and Diabetes Mellitus (DM)?

Target Blood Pressure for a 55-Year-Old Patient with CKD and Diabetes

The correct answer is C: <130/80 mmHg. This target is explicitly recommended by the most recent and authoritative guidelines for patients with both diabetes mellitus and chronic kidney disease 1.

Primary Guideline Recommendations

For this 55-year-old patient with both DM and CKD, the blood pressure target should be systolic <130 mmHg (and lower if tolerated, but not <120 mmHg) and diastolic <80 mmHg (but not <70 mmHg). 1

Key Target Parameters:

• Systolic BP goal: Target 130 mmHg, and <130 mmHg if tolerated, but never <120 mmHg 1
• Diastolic BP goal: <80 mmHg, but not <70 mmHg 1
• This patient does NOT qualify for the elderly target range (130-139 mmHg), which only applies to patients ≥65 years of age 1

Why Not the Other Options?

Option A (<155/95) and Option B (<150/85) are incorrect because:

• These targets are far too permissive for a patient with diabetes and CKD 1
• The 150/90 mmHg target is reserved exclusively for elderly patients (≥60-80 years depending on guideline), and this patient is only 55 years old 1
• Patients with DM and CKD are at very high cardiovascular risk and require more aggressive BP control to reduce microvascular and macrovascular complications 1

Treatment Approach

First-Line Medication:

• A RAAS blocker (ACE inhibitor or ARB) is mandatory as first-line therapy in patients with both diabetes and CKD, particularly given the likely presence of proteinuria or microalbuminuria 1, 2
• Combination therapy is typically required: Most patients need dual therapy initiated with a RAAS blocker plus either a calcium channel blocker or thiazide/thiazide-like diuretic 1

Additional Considerations:

• SGLT2 inhibitors are recommended if eGFR is 30 to <90 mL/min/1.73 m² for renal protection 1
• Multiple antihypertensive agents are typically necessary to achieve target BP in CKD patients 3, 2
• Never combine an ACE inhibitor with an ARB - this combination is explicitly not recommended 1

Critical Pitfalls to Avoid

• Do not lower systolic BP below 120 mmHg - this increases risk without additional benefit and may cause hypoperfusion in CKD patients 1, 3
• Do not lower diastolic BP below 70 mmHg - excessive diastolic lowering increases cardiovascular risk in CKD patients 1, 3
• Do not apply elderly targets to this 55-year-old patient - the more permissive 130-139 mmHg range only applies to those ≥65 years 1

Supporting Evidence Quality

The 2019 ESC/EASD guidelines 1 represent the most comprehensive and recent Class I, Level A recommendations for this specific patient population. These guidelines synthesized evidence from multiple RCTs showing that:

• BP control to <140/90 mmHg reduces stroke, coronary events, and kidney disease in diabetic patients 1
• More intensive control to <130/80 mmHg provides additional stroke reduction in high-risk patients like those with DM and CKD 1
• The ACCORD trial showed no harm from targeting <130 mmHg systolic in diabetic patients, though additional benefit was limited 1

Answer: C (<130/80 mmHg) is the evidence-based target for this patient population.