Patients with Chronic Kidney Disease Might Benefit from More-Intensive BP Lowering

Summary and Comment |
September 28, 2017

Patients with Chronic Kidney Disease Might Benefit from More-Intensive BP Lowering

  1. Thomas L. Schwenk, MD

All-cause mortality was 14% lower in patients who underwent more-intensive blood pressure control.

  1. Thomas L. Schwenk, MD

Intensive blood pressure (BP) control lowers risk for adverse cardiovascular events and all-cause mortality in selected high-risk hypertensive nondiabetic patients (NEJM JW Gen Med Dec 15 2015 and N Engl J Med 2015; 373:2103), but its value in patients with chronic kidney disease (CKD; estimated glomerular filtration rate, <60 mL/minute/1.73 m2) is unclear. In a review of literature dating back to 1950, researchers identified 18 randomized controlled trials in which more-intensive BP control was compared with less-intensive control in about 16,000 patients with CKD. Mean baseline systolic BP in both groups was 148 mm Hg.

During median follow-up of 3.6 years, mean systolic BP fell by 16 mm Hg (to 132 mm Hg) in the more-intensive BP-control group and by 8 mm Hg (to 140 mm Hg) in the less-intensive group. Death occurred in 7.8% of patients who received more-intensive BP lowering and in 8.4% of patients who received less-intensive control (odds ratio, 0.86). A nonsignificant trend toward greater mortality benefit was observed with greater BP lowering.

Comment

Lower BP generally is better in treating hypertensive patients with CKD, although an editorialist notes that this meta-analysis does not address whether even more-intensive BP lowering (i.e., to a systolic BP target of ≤120 mm Hg) is beneficial. In addition, the small absolute risk reduction in this analysis (0.6 percentage points) implies a relatively high “number needed to treat” to prevent one adverse outcome.

Editor Disclosures at Time of Publication

  • Disclosures for Thomas L. Schwenk, MD at time of publication Editorial boards UpToDate

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