Patients with hypertension and chronic kidney disease who underwent more intensive BP control had reduced mortality risk, according to a systematic review and meta-analysis published in JAMA Internal Medicine.
Rakesh Malhotra, MD, MPH, of the division of nephrology and hypertension at the University of California, San Diego, and Imperial Valley Family Care Medical Group in El Centro, California, and colleagues analyzed data from 15,924 patients at least 18 years with chronic kidney disease stages 3 to 5 in 18 randomized controlled trials. Patients were randomly assigned intensive (n = 7,451) or less intensive BP control (n = 8,473).
The primary outcome was all-cause mortality during the active treatment phase of each trial. The median follow-up was 3.6 years.
At baseline, the mean systolic BP was 148 mm Hg in both groups, which decreased to 132 mm Hg in the intensive arm and 140 mm Hg in the less intensive arm.
Death occurred in 7.8% of patients in the intensive BP control group and 8.4% of patients in the less intensive group.
Patients in the more intensive group had a 14% lower risk for all-cause mortality compared with the less intensive group (OR = 0.86; 95% CI, 0.76-0.97).
Heterogeneity was not seen across studies (I2 = 0%; P for heterogeneity = .77). Similar results favoring the intensive group were seen in various subgroups, including type of treatment, baseline systolic BP of all patients, chronic kidney disease severity and achieved systolic BP of those in the more intensive group.
“Although additional studies and intensive monitoring for safety are warranted, these data support that the net benefits may outweigh the net harms of more intensive BP lowering in persons with [chronic kidney disease],” Malhotra and colleagues wrote.
“One could therefore interpret the results of this meta-analysis as solidifying existing evidence about the benefits of lowering BP to a range of 130 to 140 mm Hg, but not as proof that truly intensive BP lowering (ie, to a target < 120 mm Hg) is beneficial,” Csaba P. Kovesdy, MD, the Fred Hatch Professor of Medicine in the division of nephrology at the University of Tennessee Health Science Center in Memphis, wrote in a related editorial. – by Darlene Dobkowski
Malhotra and Kovesdy report they have no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.