What should the blood pressure be in patients with chronic kidney disease?

The Modification of Diet in Renal Disease (MDRD) Study randomized 840 patients, with nondiabetic stage 3 to 4 chronic kidney disease to a blood pressure of less than 140/90 mmHg or to a blood pressure of 125/75 mmHg (1,2). The blood pressures achieved in this study were 133/80 mmHg versus 126/77 mmHg. The mean followup was 2.2 years. This study did not show a difference in death and in kidney failure between the 2 blood pressure groups. However, this study showed that in patients with proteinuria greater than 1,000 mg per day, the lower blood pressure group had a significant slower rate of decline in glomerular filtration rate (1,2).