Intensive vs Standard BP Control: Which Is Better for CKD Progression?

Intensive blood pressure (BP) control does not provide better renal outcomes in patients without diabetes who have chronic kidney disease (CKD) than standard BP control, according to a recent systematic review and meta-analysis. However, nonblack patients or those with heavy proteinuria may benefit.

The ideal BP target for renoprotection in patients without diabetes who have CKD is still debated among treatment professionals. Therefore, the researchers aimed to better understand the effects of BP on major renal outcomes in this patient population.
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The systematic review and meta-analysis evaluated 9 randomized clinical trials with 8127 adult patients with a median follow-up of 3.3 years. Data was obtained from publications up to March 24, 2016, via searches of PubMed, MEDLINE, Embase, and Cochrane Library databases, and was analyzed using random-effects meta-analyses for pooling effect measures and by meta-regression and subgroup analyses for exploring heterogeneity.

Using the data to compare an intensive BP target (less than 130/80 mm Hg) with a standard one (less than 140/90 mm Hg), the researchers analyzed changes in glomerular filtration rate (GFR); differences in doubling of serum creatinine level or 50% reduction in GFR, end-stage renal disease (ESRD), or renal outcomes; and all-cause mortality.

Results indicated that intensive BP control did not demonstrate a significant difference on any primary outcomes examined, when compared with standard BP control.

However, nonblack patients, as well as patients with higher levels of proteinuria, tended to show a lower risk of kidney disease progression with intensive BP control.

“Targeting BP below the current standard did not provide additional benefit for renal outcomes compared with standard treatment during a follow-up of 3.3 years in patients with CKD without diabetes,” the researchers concluded. “However, nonblack patients or those with higher levels of proteinuria might benefit from the intensive BP-lowering treatments.”

—Christina Vogt

Reference:

Tsai W-C, Wu H-Y, Peng Y-S, 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. 2017;177(6):792-799. doi:10.1001/jamainternmed.2017.0197.