Key result
Intensive blood pressure management in patients with chronic kidney disease reduced cardiovascular disease mortality (RR 0.69; 95% CI 0.53-0.90; P=0.01) and all-cause mortality.
Why the study?
Appropriate blood pressure targets in patients with chronic kidney disease remain uncertain.
Does intensive blood pressure management reduce mortality and cardiovascular events in patients with chronic kidney disease?
Meta-Analysis (n=20,059)
Does intensive blood pressure management reduce mortality and cardiovascular events in patients with chronic kidney disease?
Intensive blood pressure management in patients with chronic kidney disease significantly reduces all-cause and cardiovascular mortality, as well as composite cardiovascular events, without increasing serious adverse events.
Supports intensive BP targets in CKD to reduce mortality; confirms benefit across randomized trials.
Blood pressure (BP) variability is highly correlated with cardiovascular and kidney outcomes in patients with chronic kidney disease (CKD). However, appropriate BP targets in patients with CKD remain uncertain. We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) of CKD patients who underwent intensive BP management. Kappa score was used to assess inter-rater agreement. A good agreement between the authors was observed to inter-rater reliability of RCTs selection (kappa = 0.77; P = 0.005). Ten relevant studies involving 20 059 patients were included in the meta-analysis. Overall, intensive BP management may reduce the incidence of cardiovascular disease mortality (RR: 0.69, 95% CI: 0.53 to 0.90, P: 0.01), all-cause mortality (RR: 0.77, 95% CI: 0.67 to 0.88, P < 0.01) and composite cardiovascular events (RR: 0.84 95% CI: 0.75 to 0.95, P < 0.01) in patients with CKD. However, reducing BP has no significant effect on the incidence of doubling of serum creatinine level or 50% reduction in GFR (RR: 1.26, 95% CI: 0.66 to 2.40, P = 0.48), composite renal events (RR 1.07, 95% CI: 0.81 to 1.41, P = 0.64) or SAEs (RR: 0.97, 95% CI: 0.90 to 1.05, P = 0.48). In patients with CKD, enhanced BP management is associated with reduced all-cause mortality, cardiovascular mortality, and incidence of composite cardiovascular events.
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Zhang et al. (2021) conducted a meta-analysis in Chronic kidney disease (n=20,059). Intensive blood pressure management was evaluated on Cardiovascular disease mortality (RR 0.69, 95% CI 0.53 to 0.90, p=0.01). Intensive blood pressure management in patients with chronic kidney disease reduced cardiovascular disease mortality (RR 0.69; 95% CI 0.53-0.90; P=0.01) and all-cause mortality.
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