HypertensionMeta-analysis
Intensive vs Standard Blood Pressure Lowering in People With and Without Chronic Kidney Disease
- systematic review and meta-analysis
- randomized clinical trials
- inverse variance weighting
- standardized according to the between-group difference in achieved systolic blood pressure (BP) (systolic BP (SBP))
Authors' conclusion
Results of this systematic review and meta-analysis indicate that in adults with or without CKD, intensive BP lowering reduced the risk of cardiovascular events by 15% per 10-mm Hg lower SBP and increased the risk of sustained declines in eGFR, without an increase in risk of kidney failure. However, since baseline cardiovascular risk is higher in CKD, the absolute reduction in cardiovascular events was at least as large in this population; therefore, intensive BP lowering should be recommended in people with and without CKD.
Study context
- Population
- Adults with and without chronic kidney disease (CKD) in randomized clinical trials of intensive vs standard BP lowering with at least 1 year of follow-up
- Participants
- 88,830 adults · 27 studies
- Comparison
- intensive vs standard BP lowering
- Outcome
- Major cardiovascular events
Pooled result
As reported in the abstract
Relative risk
0.85 per 10-mm Hg lower SBP
95% CI 0.81–0.89
Intensive BP lowering vs Standard BP lowering
RR 0.85 per 10-mm Hg lower SBP (95% CI 0.81–0.89)
- Estimated (SE) absolute reduction, individuals with CKD
- 4.3 (1.2) cardiovascular events per 1000 person-years
- Estimated (SE) absolute reduction, individuals without CKD
- 2.7 (0.4) events per 1000 person-years
Further pooled results
| Outcome | Estimate | |
|---|---|---|
| Kidney failure · did not affect risk · without heterogeneity by CKD subgroup | RR 0.97 per 10-mm Hg reduction (95% CI 0.84–1.11) | |
| 57% sustained eGFR decline · did not affect risk · without heterogeneity by CKD subgroup | RR 0.97 (95% CI 0.83–1.14) | |
| 50% sustained eGFR decline · did not affect risk · without heterogeneity by CKD subgroup | RR 1.29 (95% CI 0.94–1.76) | |
| 30% or greater eGFR decline · increased risk by 42% | RR 1.42 (95% CI 1.28–1.58) | |
| 40% or greater eGFR decline · increased risk by 47% | RR 1.47 (95% CI 1.30–1.66) | |
| 0.512Relative risk (log scale) |
Original publication
Intensive vs Standard Blood Pressure Lowering in People With and Without Chronic Kidney Disease. JAMA Cardiol. Published 7 October 2026. doi:10.1001/jamacardio.2026.4445
Summarised from the published abstract; every number is checked against it