Evaluating blood pressure targets in chronic kidney disease: a systematic review and meta-analysis

Many studies have investigated optimal blood pressure (BP) targets in patients with chronic kidney disease (CKD); however, no consensus has been reached. We therefore conducted a systematic review and meta-analysis, including the latest randomized controlled trials (RCTs). We searched MEDLINE, the Cochrane Library, and Ichushi Web for publications up to 13 June 2024, supplemented by hand searches. We included RCTs comparing the benefits and risks of more intensive (target BP: <130/80 mmHg) versus less intensive BP control (target BP: 130-149/80-89 mmHg or usual care) in patients with CKD aged ≥18 years, regardless of diabetes status. Primary outcomes were all-cause mortality and cardiovascular events. Secondary outcomes included renal events, including 50% reduction in estimated glomerular filtration rate (eGFR)/GFR, and end-stage kidney disease (ESKD). We calculated the risk ratio (RR) and variance, and obtained summary estimates of the effects with 95% confidence intervals (CIs) using a random-effects model with inverse variance weighting. Our meta-analysis included nine RCTs. More intensive BP control tended to reduce all-cause mortality (RR = 0.81; 95% CI 0.65-1.00; p = 0.051) and cardiovascular events (RR = 0.89; 95% CI 0.77-1.03; p = 0.13), but the differences were not significant. More intensive BP control did not increase the risk of serious renal events, including 50% reduction in eGFR/GFR (RR = 0.95; 95% CI 0.74-1.22; p = 0.69) or progression to ESKD (RR = 0.92; 95% CI 0.75-1.14; p = 0.45). These findings suggest that intensive BP control targeting <130/80 mmHg may reduce the risk of all-cause mortality and cardiovascular events in patients with CKD, without increasing the risk of serious renal events. This meta-analysis of nine RCTs in patients with CKD found that more intensive BP control tended to reduce all-cause mortality and CVD events compared with less intensive control, without increasing serious kidney events, including 50% eGFR/GFR reduction, or ESKD.