This research is Trending!
Intensive vs Standard Blood Pressure Lowering in People With and Without Chronic Kidney Disease
Key result
Intensive blood pressure lowering cuts major cardiovascular events ~15% per 10-mm Hg lower systolic BP.
- RR 0.85
- 95% CI 0.81-0.89
- n=88,830
Why the study?
There is uncertainty about the effects of intensive blood pressure lowering on cardiovascular and kidney outcomes in patients with chronic kidney disease.
Does intensive blood pressure lowering reduce major cardiovascular events in adults with and without chronic kidney disease?
Study Design
Type
Meta-Analysis (n=88,830)
Multicenter
Yes
Structured PICO
Does intensive blood pressure lowering reduce major cardiovascular events in adults with and without chronic kidney disease?
P
Population
88,830 adults with and without chronic kidney disease from 27 randomized clinical trials comparing intensive vs standard blood pressure lowering, followed for at least 1 year.
I
Intervention
Intensive blood pressure lowering
C
Comparator
Standard blood pressure lowering
O
Outcome
Major cardiovascular eventscomposite
Main Result
Relative Risk: 0.85 (95% CI 0.81–0.89)
Intensive blood pressure lowering reduces the risk of cardiovascular events in adults with and without CKD, and despite an increase in sustained eGFR declines, it does not increase the risk of actual kidney failure.
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“While more intensive BP lowering increased the risk of sustained declines in kidney function, these did not translate into an increased risk of kidney failure, with a suggestion there are net benefits on mortality. These data should encourage clinical guidelines to recommend intensive BP lowering in patients with and without CKD to reduce cardiovascular risk and encourage clinicians to implement such regimens with careful kidney function monitoring.”
“Decisions to target blood pressure to < 120 mm Hg should be personalized, as it would not be appropriate for all patients with CKD.”
Implication
Supports intensive BP lowering to reduce cardiovascular events regardless of CKD status; extends evidence by confirming no increase in kidney failure.
Abstract
Importance There is uncertainty about the effects of intensive blood pressure (BP) lowering on risks of cardiovascular disease and kidney failure in patients with chronic kidney disease (CKD). Objective To assess the standardized effects of intensive BP lowering on cardiovascular and kidney outcomes overall, and then to assess for effect modification by CKD status. Data Sources MEDLINE and Embase databases were searched from inception to January 16, 2026. Study Selection Randomized clinical trials comparing intensive vs standard BP lowering in adults with and without CKD, with at least 1 year of follow-up, were eligible for inclusion. Data Extraction and Synthesis Meta-analyses were performed using inverse variance weighting after standardizing trial results according to the between-group difference in achieved systolic BP (SBP). Differences in relative effects between CKD and non-CKD populations were assessed using χ 2 tests for heterogeneity. Main Outcomes and Measures The primary outcome was major cardiovascular events; secondary outcomes included kidney failure and estimated glomerular filtration rate (eGFR)–based surrogate outcomes for kidney failure. Results We identified 27 studies including 88 830 participants. Intensive BP lowering reduced the risk of cardiovascular events by 15% per 10-mm Hg lower SBP (relative risk [RR], 0.85; 95% CI, 0.81-0.89), without heterogeneity by CKD status. This corresponded to an estimated (SE) absolute reduction of 4.3 (1.2) cardiovascular events per 1000 person-years in individuals with CKD and 2.7 (0.4) events per 1000 person-years in those without CKD. Intensive BP lowering did not affect risk of kidney failure (RR per 10-mm Hg reduction, 0.97; 95% CI, 0.84-1.11) nor risk of 57% or 50% sustained eGFR declines (RR, 0.97; 95% CI, 0.83-1.14; and RR, 1.29; 95% CI, 0.94-1.76, respectively), without heterogeneity by CKD subgroup. Intensive BP lowering increased risk of 30% or greater and 40% or greater declines by 42% (RR, 1.42; 95% CI, 1.28-1.58) and 47% (RR, 1.47; 95% CI, 1.30-1.66). Conclusions and Relevance Results of this systematic review and meta-analysis indicate that in adults with or without CKD, intensive BP lowering reduced the risk of cardiovascular events by 15% per 10-mm Hg lower SBP and increased the risk of sustained declines in eGFR, without an increase in risk of kidney failure. However, since baseline cardiovascular risk is higher in CKD, the absolute reduction in cardiovascular events was at least as large in this population; therefore, intensive BP lowering should be recommended in people with and without CKD.
JAMA Cardiology · meta-analysis. Intensive BP lowering reduces cardiovascular events regardless of CKD status Intensive vs Standard Blood Pressure Lowering in People With and Without Chronic Kidney Disease 88,830 adults: Pooled from 27 randomized trials, with and without CKD. Compared across CKD status: Intensive BP lowering vs Standard BP lowering. 15% fewer cardiovascular events. RR 0.85 (95% CI 0.81–0.89). Per 10-mm Hg lower systolic BP, no CKD heterogeneity. Kidney failure unchanged; eGFR declines rose: Kidney failure same, 30% eGFR decline, 40% eGFR decline. Parminder K. Judge (Nephrologist and researcher, University of Oxford · University of Oxford): “In adults with or without CKD, intensive BP lowering reduced the risk of cardiovascular events by 15% per 10-mm Hg lower SBP” From their public comments on the paper Bottom line: Intensive BP lowering cuts cardiovascular events regardless of CKD, without more kidney failure.
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
Iatridi et al. (2026) conducted a meta-analysis in Chronic kidney disease (n=88,830). Intensive blood pressure lowering vs. Standard blood pressure lowering was evaluated on Major cardiovascular events (RR 0.85, 95% CI 0.81-0.89). Intensive blood pressure lowering reduced the risk of major cardiovascular events by 15% per 10-mm Hg lower systolic blood pressure (RR 0.85; 95% CI 0.81-0.89).