In Nondiabetic CKD, No Overall Benefit of Intensive BP Control

Intensive blood pressure control does not further reduce the risk of kidney disease progression among nondiabetic patients with kidney disease, concludes a meta-analysis in JAMA Internal Medicine.

A systematic review identified nine randomized controlled trials comparing intensive BP control—targeting levels less than 130/80 mm Hg—with standard BP control in CKD patients without diabetes. The studies included a total of 8127 patients with a median follow-up time of 3.3 years, including more than 800 kidney disease progression events. Meta-analysis was performed for the outcomes of annual rate of change in glomerular filtration rate (GFR), doubling of serum creatinine or 50% reduction in GFR, end-stage renal disease, a composite renal outcome, and all-cause mortality.

In the overall patient population, there was no significant difference in progression of renal disease or mortality with intensive versus standard BP control. However, there was a trend toward lower kidney disease progression with intensive BP control among nonblack patients and those with higher levels of proteinuria. Adverse events were similar between groups, except for a higher rate of dizziness with intensive BP control.

Most CKD patients do not have diabetes, and BP control can reduce decline in renal function and cardiovascular risk. Previous studies of intensive BP control in this large group of patients have yielded conflicting results.

The new meta-analysis of more than 8000 nondiabetic CKD patients with 3 years’ follow-up shows no reduction in kidney disease progression with intensive versus standard BP control. However, the data show a trend toward reduced kidney disease progression in nonblack patients and those with heavy proteinuria. Adverse events appear similar at both BP targets [Tasi W-C, et al. Association of intensive blood pressure control and kidney disease progression in nondiabetic patients with chronic kidney disease: a systematic review and meta-analysis. JAMA Intern Med. Published online March 13, 2017. doi:10.1001/jamainternmed.2017.0197].