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Effects of Intensive Systolic Blood Pressure Control on Kidney Outcomes in Patients With and Without CKD: A Post Hoc

Xiaoli Xu1,2, Xuan Zhao1,2, Yi Ding1,2

  • 1Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Journal of Diabetes
|October 21, 2025
PubMed

Insights

Intensive blood pressure control may increase mild chronic kidney disease (CKD) progression but does not worsen advanced CKD or renal failure risk. This finding is crucial for managing hypertension and kidney health.

Area of Science:

  • Nephrology
  • Cardiology
  • Hypertension Management

Background:

  • The impact of intensive blood pressure (BP) control on kidney outcomes is not fully understood.
  • Previous studies have not definitively established the risks associated with intensive BP management for individuals with or without chronic kidney disease (CKD).

Purpose of the Study:

  • To investigate the effects of intensive BP control versus standard BP control on adverse kidney outcomes.
  • To compare the risks of kidney events in participants with and without baseline CKD under different BP control strategies.

Main Methods:

  • A post hoc analysis of Systolic Blood Pressure Intervention Trial (SPRINT) and Action to Control Cardiovascular Risk in Diabetes Blood Pressure (ACCORD-BP) participants.
  • Compared risks of kidney events between intensive (systolic BP < 120 mmHg) and standard (systolic BP < 140 mmHg) BP control using Cox proportional hazards models.
  • Stratified analysis for participants with and without baseline CKD.

Main Results:

  • Intensive BP control reduced renal failure risk in participants with CKD (HR=0.46) but not in those without CKD (HR=0.88).
  • Increased risk of ≥30% estimated glomerular filtration rate (eGFR) reduction and decreased risk of albuminuria were observed with intensive BP control.
  • Intensive BP control was associated with increased risk of CKD progression to moderate- or high-risk categories, but not very-high risk (KDIGO classification).

Conclusions:

  • Intensive BP control may elevate the risk of mild CKD progression.
  • The risk of advanced CKD progression or renal failure was not significantly increased by intensive BP control compared to standard control.
  • Findings suggest a nuanced approach to intensive BP management based on CKD status.
Abstract

Keywords:
albuminuriablood pressure controlchronic kidney diseaseestimated glomerular filtration raterenal failure

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