What is the clinical evidence from this study?

Study design: Review. Population: Chronic kidney disease and hypertension. Intervention: Intensive blood pressure control vs. Standard blood pressure control.

June 21, 2021Open Access

Blood pressure control in patients with chronic kidney disease

Key Result

Intensive blood pressure control targeting a systolic blood pressure of < 120 mmHg is recommended for patients with chronic kidney disease to improve cardiovascular outcomes and reduce mortality.

Structured PICO

Does intensive blood pressure control reduce cardiovascular events and CKD progression in patients with chronic kidney disease?

Population

Patients with chronic kidney disease (CKD)

Intervention

Intensive blood pressure control (e.g., target systolic blood pressure < 120 mmHg or < 130 mmHg)

Comparator

Standard blood pressure control (e.g., target systolic blood pressure < 140 mmHg)

Outcome

Cardiovascular events, all-cause mortality, and chronic kidney disease progressioncomposite

Intensive blood pressure control in patients with CKD reduces cardiovascular events and mortality but carries a risk of eGFR decline, highlighting a trade-off between cardiovascular benefit and potential kidney injury.

Limitations

Lack of randomized controlled trials involving only patients with CKD, particularly those with advanced CKD
Optimal blood pressure reduction to achieve all clinical goals has not been definitively determined

Abstract

Uncontrolled blood pressure (BP) in patients with chronic kidney disease (CKD) can lead to serious adverse outcomes. To prevent the occurrence of cardiovascular events (CVEs), and end-stage kidney disease, achieving an optimal BP level is important. Recently, there has been a paradigm shift in the management of BP largely as a result of the Systolic Blood Pressure Intervention Trial (SPRINT), which showed a reduction in CVEs by lowering systolic BP to 120 mmHg. A lower systolic blood pressure (SBP) target has been accepted by the Kidney Disease: Improving Global Outcomes (KDIGO) 2021 guidelines. However, whether intensive control of SBP targeting < 120 mmHg is also effective in patients with CKD is controversial. Notably, this lower target SBP is associated with a higher risk of adverse kidney outcomes. Unfortunately, there have been no randomized controlled trials on this issue involving only patients with CKD, particularly those with advanced CKD. In this review, we discuss the optimal control of BP in patients with CKD in terms of reduction in death and CVEs as well as attenuation of CKD progression based on the evidence-based literature.

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