Key result
Intensive systolic BP control cuts all-cause mortality ~28% and improves cardiovascular outcomes in CKD.
Why the study?
Cardiovascular disease is the leading cause of morbidity and mortality in CKD patients, with hypertension contributing significantly to vascular damage and cardiovascular risk.
Does blood pressure control reduce cardiovascular events in adult patients with chronic kidney disease stages 3-5 or on dialysis?
Systematic Review
Does blood pressure control reduce cardiovascular events in adult patients with chronic kidney disease stages 3-5 or on dialysis?
Targeted blood pressure control, particularly intensive systolic BP lowering, reduces cardiovascular risk and mortality in CKD patients, but requires individualized management to minimize adverse renal outcomes.
Answers are grounded in this paper and cite their sources.
Supports intensive systolic control in CKD; reinforces mortality benefit while requiring individualized renal monitoring.
Cardiovascular disease remains the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), with hypertension, common in this population, contributing significantly to vascular damage and cardiovascular risk. This systematic review evaluates the impact of blood pressure (BP) control on cardiovascular outcomes in individuals with CKD. A comprehensive search of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science up to May 5, 2025, identified randomized controlled trials (RCTs) and prospective comparative studies assessing BP interventions and cardiovascular outcomes in CKD populations. Methodological quality was appraised using the Modified Downs and Black checklist. Of the 11,606 studies screened, 10 met the inclusion criteria. Interventions included intensive BP targets, renin-angiotensin-aldosterone system (RAAS) blockers, sodium-glucose cotransporter-2 (SGLT2) inhibitors, and antioxidant therapies. Most studies reported significant reductions in cardiovascular events, particularly with intensive BP control, though risks such as acute kidney injury (AKI) and hyperkalemia were noted. Nutraceuticals showed potential for anti-inflammatory and BP-lowering benefits. Overall, the methodological quality was high, with most studies rated as good to excellent. Targeted BP control appears to significantly reduce cardiovascular risk in CKD patients; however, individualized treatment strategies are essential to minimize adverse renal outcomes. While the evidence supports the cardiovascular benefits of BP management in this population, further research is needed to optimize intervention strategies and define safety thresholds.
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Ahmed et al. (2025) conducted a systematic review in Chronic Kidney Disease. Blood pressure control strategies vs. Usual care, placebo, or alternative antihypertensive regimens was evaluated on Cardiovascular outcomes (myocardial infarction, heart failure, stroke, cardiovascular mortality, or surrogate markers). Targeted blood pressure management, particularly intensive systolic control (<120 mmHg), reduced all-cause mortality and improved cardiovascular outcomes in patients with chronic kidney disease.
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