Cardiometabolic & kidneyMeta-analysis
Pharmacological blood-pressure lowering for the prevention of cardiovascular disease and death across the full spectrum of chronic kidney disease severity: an individual-participant data meta-analysis
- Individual-participant data meta-analysis of randomised trials
- one-stage
- stratified network meta-analysis
- prespecified subgroups
Authors' conclusion
In the context of cardiovascular risk reduction, the relative benefit of blood-pressure lowering in patients with CKD is similar to that in individuals without CKD, with consistent efficacy across all CKD stages, blood-pressure thresholds, and proteinuria status.
Study context
- Population
- Participants of randomised controlled trials (RCTs) of BP-lowering treatment (BPLTTC dataset), across the full spectrum of chronic kidney disease (CKD) stages; history of HF or extreme creatinine excluded
- Participants
- 285,124 participants · 46 RCTs
- Comparison
- BP-lowering therapy vs comparator
- CKDn = 59,185
- Outcome
- Major CV events:
- Fatal or non-fatal stroke
- Ischaemic heart disease
- Hospitalisation for
- Death from
- HF
- Follow-up
- Median 4.4 years (IQR 3.2-5.1)
Pooled result
As reported in the abstract
Major CVD per 5 mm Hg SBP reduction, by CKD status · median 4.4 years
Hazard ratio (95% CI)
CKD
0.91(0.87–0.94)
No CKD
0.90(0.88–0.93)
Per 5 mm Hg SBP reduction, as printed
Further pooled results
| Outcome | HR (95% CI) | |
|---|---|---|
| Major CVD in CKD, by coexisting diabetes (subgroup) — CKD with diabetes vs No CKD | 0.96 (0.90–1.02) | |
| Major CVD in CKD, by coexisting diabetes (subgroup) — CKD without diabetes vs No CKD | 0.88 (0.84–0.93) | |
| 0.512Hazard ratio (log scale) |
- Major CVD in CKD, by coexisting diabetes (subgroup): interaction P=0.044
Major CVD by CKD stage (1-5)
- Relative risk reductions consistent across all CKD stages, including severe stages 4-5
- P for interaction > 0.99
Major CVD by proteinuria status and BP category
- Similar treatment effects by proteinuria status and across BP categories, down to <120/70 mm Hg
Class-specific effects of antihypertensives vs placebo on CVD (stratified network meta-analysis)
- Class-specific effects unchanged across the investigated subgroups
Original publication
Pharmacological blood-pressure lowering for the prevention of cardiovascular disease and death across the full spectrum of chronic kidney disease severity: an individual-participant data meta-analysis. Lancet. Published 25 April 2026. doi:10.1016/s0140-6736(26)00367-3
Summarised from the published abstract; every number is checked against it