Key result
Intensive BP control consistently reduces cardiovascular events across CKM stages 2-4, despite varying renal outcomes.
Why the study?
Evidence regarding the benefits and harms of intensive blood pressure control across different stages of Cardiovascular-Kidney-Metabolic (CKM) syndrome was limited.
Does intensive blood pressure control (targeting systolic BP <120 mm Hg) reduce the composite of myocardial infarction, revascularisation, hospitalization for heart failure, stroke, or cardiovascular death across different stages of Cardiovascular-Kidney-Metabolic (CKM) syndrome?
RCT (n=11,255)
Does intensive blood pressure control (targeting systolic BP <120 mm Hg) reduce the composite of myocardial infarction, revascularisation, hospitalization for heart failure, stroke, or cardiovascular death across different stages of Cardiovascular-Kidney-Metabolic (CKM) syndrome?
Intensive systolic blood pressure lowering to <120 mm Hg provides consistent cardiovascular benefits in high-risk hypertensive patients across Stages 2 to 4 of CKM syndrome, although kidney safety outcomes vary by CKM stage.
Consistent relative effects of intensive BP lowering across CKM stages; leaves open stage-specific absolute benefits and targets.
Background Evidence regarding the benefits and harms of intensive blood pressure control in patients with different stages of Cardiovascular-Kidney-Metabolic (CKM) syndrome remains limited. Methods From the ESPRIT trial (Effects of intensive Systolic blood Pressure lowering treatment in reducing RIsk of vascular evenTs), participants with complete data were categorized by CKM staging followed AHA guidelines. The primary outcome was a composite of myocardial infarction, revascularisation, hospitalization for heart failure, stroke or death from cardiovascular causes. We used Cox proportional hazards models to evaluate the effects of intensive treatment on primary outcome, MACE (a composite of myocardial infarction, hospitalization for heart failure, stroke, or death from cardiovascular diseases) all-cause death, and safety outcomes (kidney outcomes, and other serious adverse events of special interest [hypotension, syncope, electrolyte abnormality, injurious fall, or acute kidney injury]. Results We included 11,255 participants whose average age was 64.6 ± 7.1 years. Of the total participants, 2,542 (22.6%) were stage 2 CKM, 2,836 (25.2%) were stage 3 CKM, and 5,877 (52.2%) were stage 4 CKM. The effect of intensive treatment on primary and secondary outcomes did not differ significantly on the relative scale (Pinteraction > 0.05). Furthermore, no significant interaction (except for kidney outcome; Pinteraction = 0.008]) was observed between CKM stages and the risk of serious adverse events associated with intensive treatment (Pinteraction > 0.05). Conclusion Hypertensive patients with high cardiovascular risk benefit from the treatment strategy of targeting systolic BP <120 mm Hg, regardless of their CKM stage status. In addition, the effects of intensive treatment on experiencing adverse events did not differ by CKM status except for kidney outcome.Forest plot
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Y Li (2026) conducted an RCT in Hypertension with high cardiovascular risk and Cardiovascular-Kidney-Metabolic (CKM) syndrome (stages 2-4) (n=11,255). Intensive systolic blood pressure lowering treatment was evaluated on Composite of myocardial infarction, revascularisation, hospitalization for heart failure, stroke or death from cardiovascular causes (p=> 0.05 for interaction). Intensive blood pressure control (<120 mm Hg) reduced primary cardiovascular events similarly across CKM stages 2-4 (P-interaction >0.05), though kidney outcomes varied (P-interaction=0.008).
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