Effects of intensive blood pressure control on mortality and cardiorenal function in chronic kidney disease patients.

ABSTRACT

BACKGROUND: Blood pressure (BP) variability is highly correlated with cardiovascular and kidney outcomes in patients with chronic kidney disease (CKD). However, appropriate BP targets in patients with CKD remain uncertain. METHODS: We searched PubMed, Embase, and the Cochrane Library for randomized controlled trials (RCTs) of CKD patients who underwent intensive BP management. Kappa score was used to assess inter-rater agreement. A good agreement between the authors was observed to inter-rater reliability of RCTs selection (kappa = 0.77; P = 0.005). RESULTS: Ten relevant studies involving 20 059 patients were included in the meta-analysis. Overall, intensive BP management may reduce the incidence of cardiovascular disease mortality (RR 0.69, 95% CI 0.53 to 0.90, P 0.01), all-cause mortality (RR 0.77, 95% CI 0.67 to 0.88, P < 0.01) and composite cardiovascular events (RR 0.84 95% CI 0.75 to 0.95, P < 0.01) in patients with CKD. However, reducing BP has no significant effect on the incidence of doubling of serum creatinine level or 50% reduction in GFR (RR 1.26, 95% CI 0.66 to 2.40, P = 0.48), composite renal events (RR 1.07, 95% CI 0.81 to 1.41, P = 0.64) or SAEs (RR 0.97, 95% CI 0.90 to 1.05, P = 0.48). CONCLUSION: In patients with CKD, enhanced BP management is associated with reduced all-cause mortality, cardiovascular mortality, and incidence of composite cardiovascular events.