Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis

Lv, Jicheng; Ehteshami, Parya; Sarnak, Mark J.; Tighiouart, Hocine; Jun, Min; Ninomiya, Toshiharu; Foote, Celine; Rodgers, Anthony; Zhang, Hong; Wang, Haiyan; Strippoli, Giovanni F.M.; Perkovic, Vlado

doi:10.1503/cmaj.121468

Cited by 257 publications

(162 citation statements)

References 39 publications

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“…However, the present study was not adequately statistically powered to determine each outcome, owing to a rather small number of events. Regarding renal outcomes, previous literature reported that lower BP was related to better renal outcomes [9]. In the present study, SBP C 140 mmHg was associated with an increased risk of renal outcomes, and we did not clearly observe lower BPs at which renal benefits were lost.…”

Section: Discussioncontrasting

confidence: 90%

“…Aggressive BP control has been reported to effectively prevent the progressive decline in kidney function [9]; however, the lower limit of the optimal BP target for the prevention of CVD in Asian patients with CKD remains unclear. Therefore, the present study aimed to address 2 aspects of the issue regarding BP in Japanese patients with CKD, namely the risk of renal and nonrenal events.…”

Section: Discussionmentioning

confidence: 99%

“…A recent meta-analysis concerning CKD concluded that although an intensive BP-lowering strategy reduced the risk of renal outcomes, it had no clear effect on the risk of cardiovascular events (CVEs) and death [9], indicating a gap between the optimal BP in terms of renal and nonrenal outcomes (cardiac disease, stroke, and premature death) in CKD populations. This is particularly important in terms of ethnicity because of the differences in the type of cardiovascular disease (CVD) between Western and Asian populations [10], namely the high prevalence of cardiac disorders in the former and stroke in the latter.…”

Section: Introductionmentioning

confidence: 99%

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Relationship between low blood pressure and renal/cardiovascular outcomes in Japanese patients with chronic kidney disease under nephrologist care: the Gonryo study

et al. 2015

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Background Previous studies established a J-shaped association between blood pressure (BP) and cardiovascular disease (CVD) in chronic kidney disease (CKD), and the different clinical profiles of CVD by ethnicity. However, the adequately lower BP target remains unclear in Asian patients with CKD. Methods This prospective observational study included 2,655 Japanese outpatients with CKD under nephrologist care who met the inclusion criteria, namely estimated glomerular filtration rate \60 mL/min and/or presenting proteinuria. The patients were divided by 10-mmHg BP increments by clinical data. The end points were death, cardiovascular events (CVEs), and end-stage kidney disease (ESKD) that requires renal replacement therapy. Results During a 3.02-year median follow-up, 64 patients died, 120 developed CVEs, and 225 progressed to ESKD. In the adjusted Cox models, the risks of CVEs and allcause mortality were higher in the patients with systolic BPs (SBPs) \ 110 mmHg than in those with SBPs of 130-139 mmHg. Moreover, the risk was higher in those with diastolic BPs (DBPs) \ 70 mmHg than in those with DBPs of 80-89 mmHg. Although SBPs C 140 mmHg were associated with higher incidence rates of ESKD, no significant increased risk was associated with BPs \ 130/ 80 mmHg. Conclusions SBPs \ 110 mmHg and DBPs \ 70 mmHg were independent risk factors of CVEs and all-cause mortality. No lower BPs were observed as significant risk factors of progression to ESKD. This study suggests that the lower BP target in Asian patients with CKD should be C110/70 mmHg.

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Section: Discussioncontrasting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Relationship between low blood pressure and renal/cardiovascular outcomes in Japanese patients with chronic kidney disease under nephrologist care: the Gonryo study

et al. 2015

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“…In another meta-analysis that was limited to patients with CKD but included several observational follow up cohorts such as from the AASK study [13] Lv et al [16] showed a benefit of intensive blood pressure lowering and more so among patients with proteinuria. There was no clear benefit of aggressive BP lowering on the risk of cardiovascular events or death.…”

Section: Meta Analyses Of Bp Targets In Ckdmentioning

confidence: 99%

What Are Optimal Blood Pressure Targets for Patients with Hypertension and Chronic Kidney Disease?

Modi¹,

Agarwal

2015

Curr Cardiol Rep

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“…A meta-analysis reported in 2013 of 11 randomized trials in 9287 patients with chronic kidney disease and 1,264 kidney failure events showed that intensive blood pressure lowering reduced the incidence of kidney failure 27% but not in patients who did not have baseline proteinuria (9). Another meta-analysis reported in 2013 included 26 randomized trials with 30,295 patients with chronic kidney disease (10).…”

mentioning

confidence: 99%

What should the blood pressure be in patients with chronic kidney disease?

Aronow

2017

Ann. Transl. Med.

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Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis

Cited by 257 publications

References 39 publications

Relationship between low blood pressure and renal/cardiovascular outcomes in Japanese patients with chronic kidney disease under nephrologist care: the Gonryo study

Relationship between low blood pressure and renal/cardiovascular outcomes in Japanese patients with chronic kidney disease under nephrologist care: the Gonryo study

What Are Optimal Blood Pressure Targets for Patients with Hypertension and Chronic Kidney Disease?

What should the blood pressure be in patients with chronic kidney disease?

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