A new study published in JAMA Network Open indicates that intensive blood pressure (BP) control, targeting systolic BP <120 mm Hg, may offer significant cardiovascular benefits to adults with chronic kidney disease (CKD) in everyday clinical practice. The research, led by investigators from the Veterans Health Administration (VHA) and Kaiser Permanente of Southern California (KPSC), suggests that the positive outcomes observed in clinical trials like SPRINT (Systolic Blood Pressure Intervention Trial) are potentially generalizable to broader CKD populations.
The study leveraged data from 85,938 adults with CKD in the VHA database and 13,983 from the KPSC database, comparing outcomes associated with intensive BP control versus standard BP control (systolic BP <140 mm Hg). The primary endpoint was a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, or death from cardiovascular causes.
Key Findings on Cardiovascular Outcomes
The results indicated that intensive BP treatment was associated with lower absolute risks for major cardiovascular events at 4 years by approximately 5.1% (95% CI, -9.8% to -3.2%) and 3.0% (95% CI, -6.3% to -0.3%) in the VHA and KPSC populations, respectively. However, the study also noted higher risks for adverse events (AEs) with intensive treatment, with increases of about 1.3% (95% CI, -5.5% to 7.7%) in the VHA population and 3.1% (95% CI, -1.5% to 8.3%) in the KPSC population.
Adverse Events and Number Needed to Treat
In the KPSC population, the number needed to treat (NNT) with intensive BP control over 4 years to prevent one cardiovascular event or cardiovascular death was 33. The NNT to prevent one all-cause death was 44, while the number needed to cause one serious adverse event was also 33. These findings suggest a need for careful consideration of the balance between benefits and risks when implementing intensive BP targets in CKD patients.
Differences from SPRINT Trial
Compared to the original SPRINT participants, the CKD patients in this study were older, had less prevalent cardiovascular disease, higher albuminuria, and used more statins. While the cardiovascular benefits of intensive BP control were largely consistent with SPRINT, the trial’s effects on cognitive outcomes and CKD progression did not fully translate to these real-world populations.
Implications for Clinical Practice
"These findings highlight the potential population-level benefits of implementing intensive BP targets in CKD management, particularly for reducing fatal and nonfatal cardiovascular events," the researchers concluded. The study underscores the importance of tailoring BP management strategies to balance cardiovascular benefits against the risk of adverse events, especially in older and more complex CKD populations.
