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Intensive versus Less-Intensive Blood Pressure Control in Chronic Kidney Disease: A Systematic Review and
Parisa Fallahtafti1, Davood Semirani-Nezhad2, Saba Maleki1
1Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
American Journal of Nephrology
|August 6, 2025
Summary
Intensive blood pressure (BP) control in chronic kidney disease (CKD) patients did not reduce mortality. This review found no significant benefits for intensive BP targets over standard control in CKD stage 3+ patients.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Epidemiology
Background:
- Optimal blood pressure (BP) targets for patients with chronic kidney disease (CKD) stage 3 or higher are debated.
- Uncertainty exists regarding the benefits of intensive BP control versus standard control in improving outcomes for these patients.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) comparing intensive versus standard BP targets in CKD stage 3+ patients.
- To assess the impact of intensive BP control on mortality and other outcomes in CKD patients.
Main Methods:
- A systematic review and meta-analysis of 11 RCTs involving 8,740 participants.
- Random-effects model was used for meta-analysis.
Main Results:
- Intensive BP control did not significantly reduce all-cause mortality compared to standard control (RR 0.91, 95% CI 0.73-1.13).
- No significant differences were observed in other assessed outcomes between the intensive and standard BP control groups.
Conclusions:
- Intensive BP control does not appear to improve overall mortality or renal outcomes in patients with CKD stage 3 or higher.
- Further large-scale, long-term studies are necessary to definitively establish optimal BP targets in this population.
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