Figure 223

Blood pressure, proteinuria, and the rate of renal disease progression: results from the Modification of Diet in Renal Disease (MDRD) trial. Shown are rates of decrease of glomerular filtration rate (GFR) for patients enrolled in the MDRD trial, depending on level of achieved treated blood pressure during the trial [21]. A component of this trial included strict versus conventional blood pressure control. The term strict was defined as target mean arterial pressure (MAP) of under 92 mm Hg. The term conventional was defined as MAP of under 107 mm Hg. The rate of decline in GFR increased at higher levels of achieved MAP in patients with significant proteinuria (>3.0 g/d). No such relationship was evident over the duration of this trial (mean, 2.2 years) for patients with less severe proteinuria. These data emphasize the importance of blood pressure in determining disease progression in patients with proteinuric nondiabetic renal disease. No distinction was made in this study regarding the relative benefits of specific antihypertensive agents. (From Peterson and coworkers [21]; with permission.)

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