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Intensive BP control does not benefit kidney disease progression

Targeting BP below the current standard did not provide better renoprotection in patients with chronic kidney disease without diabetes; however, nonblack patients and those with a higher level of proteinuria may benefit from intensive BP-lowering treatments, according to research published in JAMA Internal Medicine.

“Chronic kidney disease (CKD) is a global epidemic, and it leads to higher risks of dialysis, cardiovascular morbidity, and mortality,” Wan-Chuan Tsai, MD, from the department of internal medicine at Far Eastern Memorial Hospital in Taiwan, and colleagues wrote. “The prevalence of CKD varies from 8% to 16% worldwide, with nondiabetic CKD accounting for most of the CKD population. The development and progression of nondiabetic CKD are closely interrelated to hypertension, and [BP] control is able to decrease the risk of decline in renal function and cardiovascular mortality. However, the optimal BP target for preventing kidney disease progression remain[s] debated.”

Tsai and colleagues searched several databases through March 24, 2016 to determine the effect of intensive BP control (< 130/80 mm Hg) on major renal outcomes in patients with nondiabetic CKD in comparison to standard BP control (< 140/90 mm Hg). They analyzed nine randomized clinical trials (n = 8,127) that evaluated intensive and standard BP control in the targeted population and documented changes in glomerular filtration rate, doubling of serum creatinine level, 50% reduction in glomerular filtration rate, end-stage renal disease or all-cause mortality.

During the mean follow-up of 3.3 years, the researchers found that there were no significant differences in the annual rate of change in glomerular filtration rate (mean difference, 0.07; 95% CI, –0.16 to 0.29), doubling of serum creatinine level or 50% reduction in glomerular filtration rate (RR = 0.99; 95% CI, 0.76-1.29) between the intensive BP control and standard BP control. In addition, end-stage renal disease (RR = 0.96; 95% CI, 0.78-1.18), composite renal outcome (RR = 0.99; 95% CI, 0.81-1.21) or all-cause mortality (RR = 0.95; 95%CI, 0.66-1.37) were also not significantly different among the two groups. The researchers observed a lower risk for kidney disease progression with intensive BP control in nonblacks and patients with higher levels of proteinuria.

“Targeting BP below the current standard did not provide additional benefit for renal outcomes compared with standard treatment during a follow-up of 3.3 years in patients with CKD without diabetes,” Tsai and colleagues concluded. “However, nonblack patients or those with higher levels of proteinuria might benefit from the intensive BP lowering, and the risk of adverse events are mostly similar among different BP targets.” – by Alaina Tedesco

Disclosure: The researchers report receiving support from research grants from the National Health Research Institutes in Taiwan and the Far Eastern Memorial Hospital.