Tight BP Control May Mean Better CKD OutcomesMedPage Today #Reading_RoomAugust 8, 2019
Patients with moderate to advanced chronic kidney disease at baseline (stage 3-5 CKD) may benefit from intensive blood pressure reduction, according to a new meta-analysis.
Ix’s group showed that lowering elevated blood pressure to a target of below 140 mm Hg and possibly closer to 130 mm Hg improves all-cause mortality in patients with baseline CKD, Kovesdy concluded.
The survival benefit of intense targeting was consistent across subgroups.
Excluding the SPRINT trial in a sensitivity analysis left the investigators with similar results (SPRINT provided substantial statistical power to the meta-analysis and had demonstrated that with systolic blood pressure targeted to under-120 mm Hg instead of under-140 mm Hg, patients had a lower mortality risk but a higher acute kidney injury risk).
“The highest mortality benefit was observed in studies that achieved the greatest difference in systolic blood pressure during the trial, a result that did not reach statistical significance,” the investigators noted.
“It is possible that intensive blood pressure lowering may have a diminishing benefit along with an increase in the incidence of adverse outcomes such as acute kidney injury in patients with more advanced CKD (e.g., eGFR <30 mL/min/1.73 m 2 )," Kovesdy suggested. Two other caveats to Ix's study, per Kovesdy: the variety in blood pressure targets across the trials included and a much higher mortality rate observed in CKD patients outside these trials. "These diminishing absolute benefits have to be weighed against the increased likelihood of adverse effects and the higher costs associated with more intensive blood pressure lowering ." Click here for the American Association of Clinical Endocrinologists' resource center for the management of common comorbidities of diabetes, including chronic kidney disease. Ix and Kovesdy disclosed no relevant relationships with industry.
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