Patients with Chronic Kidney Disease Might Benefit from More-Intensive BP Lowering

Intensive blood pressure (BP) control lowers risk for adverse cardiovascular events and all-cause mortality in selected high-risk hypertensive nondiabetic patients (NEJM JW Gen Med Dec 15 2015 and N Engl J Med 2015; 373:2103), but its value in patients with chronic kidney disease (CKD; estimated glomerular filtration rate, <60 mL/minute/1.73 m²) is unclear. In a review of literature dating back to 1950, researchers identified 18 randomized controlled trials in which more-intensive BP control was compared with less-intensive control in about 16,000 patients with CKD. Mean baseline systolic BP in both groups was 148 mm Hg.

During median follow-up of 3.6 years, mean systolic BP fell by 16 mm Hg (to 132 mm Hg) in the more-intensive BP-control gr…