Pharmacological blood-pressure lowering for the prevention of cardiovascular disease and death across the full spectrum of chronic kidney disease severity: an individual-participant data meta-analysis
A meta-analysis of individual data from 46 randomized trials (285,124 people) found that lowering blood pressure cuts major cardiovascular events just as much in people with chronic kidney disease as in those without — at every CKD stage, though the benefit is smaller when diabetes is also present.
Background
People with CKD, particularly at advanced stages, have been systematically under-represented in blood-pressure-lowering trials over safety concerns, leaving a persistent evidence gap on whether the cardiovascular benefit of treatment holds across the CKD spectrum.
Key findings
Among 285,124 participants from 46 trials (59,185 [20.7%] with CKD), a 5 mm Hg systolic reduction reduced major cardiovascular disease in individuals with CKD (HR 0.91, 95% CI 0.87-0.94) and without CKD (HR 0.90, 0.88-0.93; p-interaction >0.99). Effects were consistent across all CKD stages including 4-5, across proteinuria status, and down to <120/70 mm Hg. The benefit was attenuated in CKD with concomitant diabetes (HR 0.96) versus without (HR 0.88; p-interaction 0.044).
Clinical implications
Blood-pressure lowering should be considered for cardiovascular risk reduction regardless of CKD stage, proteinuria status, or baseline blood-pressure category, with the caveat that patients with both CKD and diabetes may derive a smaller relative benefit and warrant adapted therapeutic strategies.
Category
Research
Source
The Lancet
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