Effects of Intensive BP Control in CKD

Area of Science:

• Nephrology
• Cardiology
• Clinical Trials

Background:

• The optimal systolic blood pressure (BP) target for patients with chronic kidney disease (CKD) and hypertension is not well-established.
• Subgroup analyses from major trials are crucial for understanding treatment effects in specific populations like those with CKD.

Purpose of the Study:

• To analyze the outcomes of targeting a systolic BP of <120 mm Hg versus <140 mm Hg in patients with CKD and hypertension.
• To assess the impact of intensive BP lowering on cardiovascular events, all-cause mortality, and kidney outcomes in this population.

Main Methods:

• Prespecified subgroup analyses from the Systolic Blood Pressure Intervention Trial (SPRINT) involving participants with baseline CKD.
• Random assignment to either an intensive BP target (<120 mm Hg) or a standard BP target (<140 mm Hg).
• Follow-up for major cardiovascular outcomes, all-cause death, and kidney-specific outcomes, including estimated glomerular filtration rate (eGFR) and end-stage renal disease (ESRD).

Main Results:

• The intensive BP target group showed a reduced rate of the primary composite cardiovascular outcome (HR, 0.81; 95% CI, 0.63 to 1.05) and all-cause death (HR, 0.72; 95% CI, 0.53 to 0.99) compared to the standard target group.
• No significant interaction was observed between CKD status and treatment effect for cardiovascular outcomes, suggesting similar benefits across groups.
• The intensive group experienced a slightly faster decline in eGFR after 6 months, but the main kidney outcome (composite of ≥50% eGFR decrease or ESRD) did not differ significantly between groups (HR, 0.90; 95% CI, 0.44 to 1.83).

Conclusions:

• Targeting a systolic BP of <120 mm Hg in patients with CKD and hypertension (without diabetes) effectively reduced major cardiovascular events and all-cause mortality.
• This intensive BP management strategy did not demonstrate a deleterious effect on kidney outcomes and showed consistent effects regardless of CKD status.
• While some adverse events were more frequent in the intensive group, the overall safety profile was comparable, supporting the benefit of intensive BP control in this cohort.