TOPLINE

Intensive lowering of blood pressure (BP) was associated with a reduced risk for cardiovascular events in adults with or without chronic kidney disease (CKD) and did not increase the risk for kidney failure, but it was linked to a higher risk for sustained declines in kidney function.

METHODOLOGY

• Researchers conducted a systematic review and meta-analysis to compare how intensive and standard BP lowering affected heart and kidney outcomes in adults with and without CKD.
• They searched MEDLINE and Embase from inception to January 2026 and included randomized clinical trials involving adults with specific BP targets, with at least 1 year of follow-up.
• The primary outcome was major cardiovascular events, and the main secondary outcome was kidney failure. Changes in the estimated glomerular filtration rate (eGFR) were also assessed.
• The final analysis pooled data from 27 trials involving 88,830 participants; 24 trials provided data on cardiovascular events, and 11 trials reported within-trial kidney failure outcomes.
• The average follow-up duration ranged from 1 year to 8.4 years. The risk for bias was judged to be low in 16 trials and 11 had some concerns.

TAKEAWAY

• Intensive vs standard BP lowering was associated with a 15% lower risk for cardiovascular events per 10-mm Hg reduction in systolic BP (relative risk [RR], 0.85; 95% CI, 0.81-0.89), with no significant difference noted between the CKD and non-CKD populations (P = .26 for heterogeneity).
• The relative benefit translated to about 4.2 fewer cardiovascular events per 1000 person‑years of treatment in patients with CKD and about 2.7 fewer events per 1000 person‑years of treatment in those without CKD, a difference that was not statistically significant.
• Intensive BP lowering did not affect the risk for kidney failure, regardless of CKD status (P = .77 for heterogeneity). However, each 10-mm Hg reduction in systolic BP was associated with a 42% higher risk for a 30% or more sustained eGFR decline and a 47% higher risk for a 40% or more decline, irrespective of CKD status.
• In an exploratory analysis, intensive BP lowering was linked to an 11% lower risk for all-cause mortality per 10-mm Hg lower systolic BP.

IN PRACTICE

"[The] data should encourage clinical guidelines to recommend intensive BP lowering in patients with and without CKD to reduce cardiovascular risk and encourage clinicians to implement such regimens with careful kidney function monitoring," the researchers wrote.

SOURCE

The study was led by Fotini Iatridi, PhD, of University of Oxford in Oxford, England. It was published online on October 7 in JAMA Cardiology.

LIMITATIONS

Researchers relied on published summary tables instead of individual-level data. Some individuals without CKD may have had undetected CKD. Trials used different methods to measure BP and had different targets.

DISCLOSURES

The study received funding from a fellowship program of the European Renal Association. Several authors reported receiving institutional grants from pharmaceutical companies to support clinical trials or cohort studies, some during and some outside the conduct of this work. One author reported receiving an honorarium from a pharmaceutical company and holding a steering committee role for trials funded by another. Detailed disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.