August 6, 2025

Intensive vs. Less Intensive Blood Pressure Control in Chronic Kidney Disease: A Systematic Review and Meta-analysis of Clinical Trials

PFParisa FallahtaftiBrigham and Women's Hospital DSDavood Semirani-NezhadTehran University of Medical Sciences SMSaba MalekiGuilan University of Medical Sciences

Key Points

Intensive blood pressure control does not significantly reduce all-cause mortality in chronic kidney disease patients.
The analysis included 11 randomized controlled trials with a total of 8,740 participants for comparison.
Meta-analysis showed no meaningful differences in renal outcomes between intensive and standard blood pressure control.
Findings suggest that new long-term studies are necessary to determine optimal blood pressure targets for CKD patients.

Abstract

Background: Optimal blood pressure (BP) targets in patients with chronic kidney disease (CKD) stage 3 or higher remain controversial, with uncertainty about whether intensive BP control improves outcomes compared to standard control. Summary: This systematic review and meta-analysis included 11 randomized controlled trials (RCTs) with 8,740 participants, comparing intensive versus standard BP targets in CKD stage 3+ patients. Meta-analysis using a random-effects model showed no significant reduction in all-cause mortality with intensive control (RR 0.91, 95% CI 0.73–1.13). Similarly, there were no significant differences in other outcomes. Key Messages: Intensive BP control did not improve overall mortality or renal outcomes in CKD patients. Further large, long-term studies are warranted.

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