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

Target Blood Pressure: <130/80 mmHg (Answer: C)

For a 55-year-old patient with both chronic kidney disease and diabetes mellitus, the target blood pressure should be <130/80 mmHg, which corresponds to answer C.

Guideline-Based Recommendation

• The European Society of Cardiology specifically recommends a blood pressure target of systolic <130 mmHg and diastolic <80 mmHg for patients with diabetes and chronic kidney disease, with the goal of reducing both microvascular and macrovascular complications 1

• The American College of Cardiology/American Heart Association guidelines similarly recommend <130/80 mmHg for patients with CKD and hypertension, including those with diabetes 2, 3

• The 2019 ESC/EASD guidelines provide stronger recommendations for more intensive control to <130/80 mmHg specifically in high-risk patients like those with both diabetes and chronic kidney disease 1

Why This Target Matters in Your Patient

• Patients with both diabetes and CKD represent a particularly high-risk population where tighter blood pressure control reduces stroke, coronary events, and progression of kidney disease 1, 4

• This target is lower than the standard <140/90 mmHg goal used for general hypertension because the combination of diabetes and CKD substantially increases cardiovascular and renal risk 4, 5

Critical Safety Boundaries

• Do not lower systolic blood pressure below 120 mmHg, as this may increase the risk of hypoperfusion in patients with chronic kidney disease 1

• Do not lower diastolic blood pressure below 70 mmHg, as this may increase cardiovascular risk in CKD patients 1, 3

• Avoid systolic blood pressure dropping below 110 mmHg during treatment 2

First-Line Treatment Approach

• Start with a RAAS blocker (ACE inhibitor or ARB) as first-line therapy, particularly important in patients with diabetes and CKD, especially if proteinuria or microalbuminuria is present 1, 4

• Combination therapy with a RAAS blocker plus either a calcium channel blocker or thiazide/thiazide-like diuretic is typically required to achieve target blood pressure in patients with chronic kidney disease 1, 4

Monitoring Protocol

• Check basic metabolic panel within 2-4 weeks after initiating or titrating medications to monitor for electrolyte abnormalities and changes in kidney function 2, 5

• Use home blood pressure monitoring to ensure accurate readings and avoid hypotension 2