Association of intensive blood pressure control and kidney disease progression in nondiabetic patients with chronic kidney disease: A systematic review and meta-analysis
Journal
JAMA Internal Medicine
Journal Volume
177
Journal Issue
6
Pages
792-799
Date Issued
2017
Author(s)
Tsai W.-C.
Wu H.-Y.
Peng Y.-S.
Yang J.-Y.
Chen H.-Y.
Chiu Y.-L.
Hsu S.-P.
Ko M.-J.
Pai M.-F.
Abstract
IMPORTANCE: The optimal blood pressure (BP) target remains debated in nondiabetic patients with chronic kidney disease (CKD). OBJECTIVE: To compare intensive BP control (<130/80 mm Hg) with standard BP control (<140/90 mm Hg) on major renal outcomes in patients with CKD without diabetes. DATA SOURCES Searches of PubMed, MEDLINE, Embase, and Cochrane Library for publications up to March 24, 2016. STUDY SELECTION Randomized clinical trials that compared an intensive vs a standard BP target in nondiabetic adults with CKD, reporting changes in glomerular filtration rate (GFR), doubling of serum creatinine level, 50% reduction in GFR, end-stage renal disease (ESRD), or all-cause mortality. DATA EXTRACTION AND SYNTHESIS Random-effects meta-analyses for pooling effect measures. Meta-regression and subgroup analyses for exploring heterogeneity. MAINOUTCOMES ANDMEASURES: Differences in annual rate of change in GFR were expressed as mean differences with 95% CIs. Differences in doubling of serum creatinine or 50% reduction in GFR, ESRD, composite renal outcome, and all-cause mortality were expressed as risk ratios (RRs) with 95% CIs. RESULTS: We identified 9 trials with 8127 patients and a median follow-up of 3.3 years. Compared with standard BP control, intensive BP control did not show a significant difference on the annual rate of change in GFR (mean difference, 0.07; 95% CI, -0.16 to 0.29 mL/min/1.73 m2/y), doubling of serum creatinine level or 50% reduction in GFR (RR, 0.99; 95% CI, 0.76-1.29), ESRD (RR, 0.96; 95% CI, 0.78-1.18), composite renal outcome (RR, 0.99; 95% CI, 0.81-1.21), or all-cause mortality (RR, 0.95; 95% CI, 0.66-1.37). Nonblacks and patients with higher levels of proteinuria showed a trend of lower risk of kidney disease progression with intensive BP control. CONCLUSIONS AND RELEVANCE: Targeting BP below the current standard did not provide additional benefit for renal outcomes compared with standard treatment during a follow-up of 3.3 years in patients with CKD without diabetes. However, nonblack patients or those with higher levels of proteinuria might benefit from the intensive BP-lowering treatments. ? 2017 American Medical Association. All rights reserved.
SDGs
Other Subjects
antihypertensive agent; creatinine; antihypertensive agent; beta adrenergic receptor blocking agent; acute kidney failure; antihypertensive therapy; blood pressure regulation; chronic kidney failure; Cochrane Library; creatinine blood level; disease association; disease course; dizziness; drug efficacy; drug safety; Embase; end stage renal disease; faintness; follow up; glomerulus filtration rate; human; hypertension; hypotension; kidney disease; Medline; meta analysis; mortality; multicenter study (topic); outcome assessment; priority journal; proteinuria; randomized controlled trial (topic); Review; systematic review; dose response; female; hemodialysis; Hypertension, Renal; Kidney Failure, Chronic; male; risk factor; Adrenergic beta-Antagonists; Antihypertensive Agents; Disease Progression; Dose-Response Relationship, Drug; Female; Humans; Hypertension, Renal; Kidney Failure, Chronic; Male; Renal Dialysis; Risk Factors
Publisher
American Medical Association
Type
review