Target Blood Pressure: <130/80 mmHg
For a 55-year-old patient with both CKD and diabetes, the target blood pressure should be <130/80 mmHg (Answer C). 1
Guideline-Based Recommendation
The European Society of Cardiology explicitly recommends a blood pressure target of systolic <130 mmHg and diastolic <80 mmHg for patients with both diabetes and chronic kidney disease, with the specific goal of reducing microvascular and macrovascular complications. 1 This target is more aggressive than targets for elderly patients and reflects the high cardiovascular and renal risk in this population. 1
Supporting Evidence Hierarchy
Most recent guidelines (2025) prioritize <130/80 mmHg specifically for the diabetes-CKD combination, recognizing this as a high-risk population requiring more intensive control. 1
The 2019 ESC/EASD guidelines recommend blood pressure control to <140/90 mmHg for general diabetic patients, but provide a stronger recommendation for more intensive control to <130/80 mmHg in high-risk patients like those with both diabetes and CKD. 1
Updated hypertension guidelines for patients with established CKD and/or diabetes with albuminuria recommend a blood pressure goal <130/80 mmHg. 2
A 2025 meta-analysis of nine randomized controlled trials found that intensive BP control targeting <130/80 mmHg tended to reduce all-cause mortality (RR=0.81) and cardiovascular events (RR=0.89) in CKD patients without increasing serious renal events. 3
Why Not the Other Options?
Option A (<155/95): This target is far too permissive and would expose the patient to unacceptable cardiovascular and renal risk. 1
Option B (<150/85): While older guidelines from 2003 suggested targets of <150/80 for some populations, this is outdated and insufficient for a 55-year-old with dual high-risk conditions. 4
Critical Treatment Approach
First-line therapy should be a RAAS blocker (ACE inhibitor or ARB), particularly given the likely presence of proteinuria or microalbuminuria in this population. 1, 2
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 CKD. 1
Monitor renal function and serum potassium within 1-2 weeks of initiating ACE inhibitor or ARB therapy, with each dose increase, and at least yearly. 4
Important Safety Boundaries
Do not lower systolic BP below 120 mmHg, as this may increase the risk of hypoperfusion in patients with CKD. 1
Do not lower diastolic BP below 70 mmHg, as this may increase cardiovascular risk. 1
The ACCORD trial showed no overall cardiovascular benefit at the <120 mmHg target in diabetic patients, though stroke reduction was observed. 1
Common Pitfalls to Avoid
Do not apply the more aggressive <120 mmHg systolic target from SPRINT, as that trial explicitly excluded patients with diabetes. 1
Avoid using thiazide or loop diuretics without monitoring electrolytes within 1-2 weeks of initiation and at least yearly, given the risk of hypokalemia. 4
Never combine ACE inhibitor plus ARB, as this increases adverse events without benefit. 5