Intensive BP Therapy Has Mortality Benefit for CKD Patients

Intensive blood pressure (BP) control was associated with a lower risk for all-cause mortality among patients with hypertension and chronic kidney disease (CKD), according to the findings of a new meta-analysis.

In their review, the researchers examined data from 18 trials with 15,924 participants who had CKD stages 3 to 5 and were randomly assigned to intensive BP control, less intensive BP control, placebo, or no treatment. Two researchers evaluated the quality and characteristics of the study, as well as obtained all-cause mortality of participants with CKD that occurred during the intervention phase of each trial.
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A total of 1293 participants with CKD had died during the intervention phase.

The mean systolic BP dropped significantly from 148 mmHg at baseline to 132 mmHg at follow-up among patients who received intensive BP control, compared with a slight drop among patients in the less intensive groups (from 148 mmHg to 140 mmHg).

Compared with less intensive BP control, more intensive BP control was associated with a 14% decreased risk for all-cause mortality (odds ratio 0.86). This finding was consistent across multiple subgroups and did not have significant heterogeneity, according to the researchers.

“Randomization to more intensive BP control is associated with lower mortality risk among trial participants with hypertension and CKD,” the researchers concluded. “Further studies are required to define absolute BP targets for maximal benefit and minimal harm.”

—Melissa Weiss

Reference:

Malhotra R, Nguyen HA, Benavente O, et al. Association between more intensive vs less intensive blood pressure lowering and risk of mortality in chronic kidney disease stages 3 to 5: a systematic review and meta-analysis [published online September 5, 2017]. JAMA Intern Med. doi:10.1001/jamainternmed.2017.4377.