Now that the SPRINT trial has shown that controlling blood pressure does not slow down the progression of CKD or delay the onset of ESRD. Can the same be said for the use of ace inhibitors used to maintain strict control of blood pressure?

The most common cause of death in patients with chronic kidney disease is heart attacks and stroke.  CKD does not often cause death.  Hence, the Sprint trial showed that with careful control of blood pressure, even in elderly patients with CKD results in fewer deaths from heart disease and stroke.  ACE inhibitors continue to show a slowing of the progression of CKD, especially in patient who have protein in their urine.  Hence, the lessons of the SPRINT trial have to do with death as an outcome.  The use of ACE inhibitors for slowing progression of CKD remain a very strong recommendation.  In the case of ACE inhibitors, the outcome you are measuring is the progression to kidney failure and End Stage Renal Disease (ESRD).  Hence, you cannot compare the two outcomes.  You are measuring different outcomes for each treatment recommendation.

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