Intensive blood pressure targets did not significantly improve mortality compared to standard targets in non-diabetic patients with chronic kidney disease (HR 0.84; 95% CI 0.66-1.07; p=0.148).
Meta-Analysis (n=4,537)
Yes
Does intensive blood pressure targeting reduce mortality in non-diabetic chronic kidney disease patients?
Intensive blood pressure targets do not significantly improve mortality in non-diabetic patients with chronic kidney disease compared to standard targets.
Hazard Ratio: 0.84 (95% CI 0.66–1.07)
Absolute Event Rate: 5.5% vs 6.6%
p-value: p=0.148
Introduction: Current evidence is conflicting on whether intensive blood pressure (BP) management, specifically with targets of <130/90 mmHg, produces a mortality benefit in non-diabetic chronic kidney disease (CKD) patients. MDRD, AASK, and SPRINT are the largest randomized controlled trials available investigating intensive targets in CKD patients. The MDRD and AASK recruited exclusively CKD patients, while SPRINT had a large CKD subpopulation within its cohort. MDRD assigned patients to a standard mean arterial pressure (MAP) target of 107 mmHg vs. an intensive target of 92 mmHg (achieved BPs of 134/81 mmHg vs 126/77 mmHg, respectively). AASK assigned African American patients to a MAP of 102-107 mmHg vs. <92 mmHg (achieved BPs of 141/85 mmHg vs. 128/78 mmHg, respectively). SPRINT compared a systolic target of 140 mmHg vs. 120 mmHg (achieved BPs of 137/74 vs. 123/67 in the CKD subpopulation). Our study pools individual patient data (IPD) from these three trials. Methods: IPD for all patients in MDRD, AASK, and SPRINT were obtained and screened for non-diabetic CKD patients. The resulting 4537 patients were assigned to their original randomized intervention group – 2258 patients to the standard group and 2279 to the intensive group. The primary outcome was mortality. Statistical analysis for primary outcome was performed with Cox proportional hazards models stratified by clinical site/center. Interactions between outcome and trial enrollment were also assessed. Results: There was no statistically significant difference in mortality rate between intensive and standard BP control (HR: 0.84; 95% CI: 0.66, 1.07; p = 0.148). 126 patients (5.5%) in the intensive group and 149 patients (6.6%) in the standard group expired. No interaction was present between treatment and trial enrollment (MDRD, AASK, SPRINT) (p-value of interaction: 0.080). Conclusion: Intensive BP targets do not improve mortality for non-diabetic patients with CKD. Further investigation needs to be performed to determine if this lack of benefit is consistent across subpopulations.
Aggarwal et al. (Sat,) conducted a meta-analysis in non-diabetic chronic kidney disease (n=4,537). Intensive blood pressure targets vs. Standard blood pressure targets was evaluated on mortality (HR 0.84, 95% CI 0.66-1.07, p=0.148). Intensive blood pressure targets did not significantly improve mortality compared to standard targets in non-diabetic patients with chronic kidney disease (HR 0.84; 95% CI 0.66-1.07; p=0.148).