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June 22, 2017Journal of the American Society of NephrologyOpen Access

The primary composite cardiovascular outcome occurred at a lower rate in the intensive group (HR 0.81, 95% CI 0.63 to 1.05), with a significant reduction in all-cause death (HR 0.72, 95% CI 0.53 to 0.99) and no significant difference in the main kidney outcome (HR 0.90, 95% CI 0.44 to 1.83).

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Why the study?

Does intensive systolic blood pressure control (<120 mm Hg) reduce cardiovascular events and mortality in patients with CKD and hypertension without diabetes compared to standard control (<140 mm Hg)?

Population

2,646 adults with mild to moderate chronic kidney disease and hypertension, without diabetes. Mean age 71.9…

Comparison

Intensive blood pressure control targeting a… vs Standard blood pressure control targeting a…

Design

RCT, Randomly assigned at an allocation ratio of 1:1, Open label trial

Follow-up

Median 3.3 years

Authors

ACALFRED K. CHEUNGUniversity of UtahMRMahboob RahmanUniversity Hospitals of ClevelandDRDavid M. ReboussinPreventive Cardiology

Discussion

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Overview

May reduce CV events with intensive BP control in CKD; leaves open optimal targets for dedicated trials.

Structured PICO

Does intensive systolic blood pressure control (<120 mm Hg) reduce cardiovascular events and mortality in patients with CKD and hypertension without diabetes compared to standard control (<140 mm Hg)?

P
Population
2,646 adults with mild to moderate chronic kidney disease (eGFR 20-59 ml/min per 1.73 m2) and hypertension, without diabetes. Mean age 71.9 years, 40.0% women. Key exclusions: diabetes mellitus, proteinuria >1 g/d, polycystic kidney disease, prior stroke, symptomatic heart failure, and left ventricular ejection fraction <35%.
I
Intervention
Intensive blood pressure control targeting a systolic blood pressure of <120 mm Hg using adjusted antihypertensive regimens.
C
Comparator
Standard blood pressure control targeting a systolic blood pressure of <140 mm Hg using adjusted antihypertensive regimens.
O
Outcome
Composite of nonfatal myocardial infarction, non-myocardial infarction acute coronary syndrome, nonfatal acute decompensated heart failure, nonfatal stroke, and death from cardiovascular causes.composite

In patients with mild to moderate CKD and hypertension without diabetes, targeting a systolic blood pressure <120 mm Hg reduces all-cause mortality and major cardiovascular events without worsening the main kidney outcome, despite a slight increase in acute reversible eGFR decline and electrolyte abnormalities.

Limitations

  • Progression of CKD was generally slow, resulting in a low number of main kidney events and limiting statistical power to detect a treatment effect on kidney outcomes.
  • Relatively small number of participants with advanced CKD at baseline.
  • Early termination of the intervention and shorter duration of follow-up limited the ability to evaluate long-term effects on kidney function.

Cite This Study

CHEUNG et al. (2017) studied this question.

synapsesocial.com/papers/6a6fac4684cc45bb7bdfa676https://doi.org/10.1681/asn.2017020148
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Mortality Outcomes With Intensive Blood Pressure Targets in Chronic Kidney Disease Patients2019 · 65 citations
  2. 2Effects of Intensive Systolic Blood Pressure Control on Kidney Outcomes in Patients With and Without <scp>CKD</scp>: A Post Hoc Analysis of <scp>SPRINT</scp> and <scp>ACCORD</scp>‐<scp>BP</scp> Trials2025
  3. 3Abstract P121: The Effect of Intensive Blood Pressure Targets on Mortality in Chronic Kidney Disease Patients: An Individual Patient Data Meta-Analysis of Randomized Controlled Trials2018 · 1 citations
  4. 4Impact of intensive blood pressure control on kidney outcomes2025 · 3 citations
  5. 5Evaluating the Renal Implications of Intensive Versus Standard Blood Pressure Control in Chronic Kidney Disease: A Systematic Review of Randomized Trials2025