Do blood pressure lowering regimens reduce major cardiovascular events in people with and without chronic kidney disease?
Blood pressure lowering effectively reduces major cardiovascular events similarly in patients with and without moderately reduced eGFR, regardless of the specific drug class used.
OBJECTIVE: To define the cardiovascular effects of lowering blood pressure in people with chronic kidney disease. DESIGN: Collaborative prospective meta-analysis of randomised trials. DATA SOURCES AND ELIGIBILITY: Participating randomised trials of drugs to lower blood pressure compared with placebo or each other or that compare different blood pressure targets, with at least 1000 patient years of follow-up per arm. MAIN OUTCOME MEASURES: Major cardiovascular events (stroke, myocardial infarction, heart failure, or cardiovascular death) in composite and individually and all cause death. PARTICIPANTS: 26 trials (152,290 participants), including 30,295 individuals with reduced estimated glomerular filtration rate (eGFR), which was defined as eGFR 0.60 for homogeneity). CONCLUSIONS: Blood pressure lowering is an effective strategy for preventing cardiovascular events among people with moderately reduced eGFR. There is little evidence from these overviews to support the preferential choice of particular drug classes for the prevention of cardiovascular events in chronic kidney disease.
A 2013 study studied this question.