Key result
Intensive BP control is linked to ~32% fewer CV events but increased adverse kidney events.
Why the study?
The effects of intensive SBP control on cardiovascular and kidney outcomes across different KDIGO risk categories remain unclear.
Does intensive systolic blood pressure control reduce cardiovascular events and affect kidney outcomes across different KDIGO risk categories in patients from the SPRINT and ACCORD-BP trials?
Does intensive systolic blood pressure control reduce cardiovascular events and affect kidney outcomes across different KDIGO risk categories in patients from the SPRINT and ACCORD-BP trials?
Intensive blood pressure control reduces cardiovascular events but increases kidney events, highlighting the need to balance these competing risks based on a patient's baseline KDIGO risk category.
Answers are grounded in this paper and cite their sources.
Intensive BP control may reduce CV events at kidney event cost by KDIGO risk; leaves open individualized targets in prospective trials.
The effects of intensive systolic blood pressure (SBP) control on cardiovascular (CV) and kidney outcomes across different Kidney Disease Improving Global Outcomes (KDIGO) risk categories remain unclear. We performed a secondary analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) and the SPRINT-eligible Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD-BP) trial. Participants were categorized into low, moderate, and high/very-high KDIGO risk groups. The primary outcomes were composite adverse CV events (defined as nonfatal myocardial infarction (MI), nonfatal stroke, fatal or hospitalized heart failure (HF), and CV mortality) and composite adverse kidney events (defined as a sustained decline in eGFR of ≥ 40% and end-stage kidney disease (ESKD)). We found that intensive BP control reduced the risk of composite CV events (HR 0.68; 95% CI 0.59–0.78), with attenuated benefits in higher KDIGO risk categories ( P for interaction = 0.055). This interaction was mainly driven by nonfatal MI and fatal or hospitalized HF (both P for interaction < 0.05). Intensive BP control increased the risk of composite kidney events (HR 1.88; 95% CI 1.52–2.33), mainly in low- and moderate-risk groups rather than in high/very-high risk groups ( P for interaction = 0.04). Similar patterns were observed for sustained eGFR decline ( P for interaction = 0.03), but not for ESKD (HR 1.05; 95% CI 0.74–1.48; P for interaction = 0.71). The KDIGO risk classification modified the effects of intensive BP control. Balancing CV benefits against potential kidney impacts in patients with different KDIGO risks during intensive BP treatment is recommended. Trial Registration: ClinicalTrials.gov Identifiers: NCT01206062 (SPRINT)
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Meng et al. (2026) studied Cardiovascular and kidney risk in hypertension. Intensive blood pressure control was evaluated on Composite adverse CV events (nonfatal MI, nonfatal stroke, fatal or hospitalized HF, and CV mortality) and composite adverse kidney events (sustained decline in eGFR of ≥ 40% and ESKD) (HR 0.68, 95% CI 0.59-0.78). Intensive blood pressure control reduced composite CV events (HR 0.68; 95% CI 0.59-0.78) but increased composite kidney events (HR 1.88; 95% CI 1.52-2.33), with effects modified by KDIGO risk.
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