Blood pressure reduction supported for early-stage kidney disease

Oct 14 2013

By Eleanor McDermid, Senior medwireNews Reporter

Blood pressure reduction per se, rather than the particular antihypertensive used, reduces the risk for cardiovascular events in patients with chronic kidney disease (CKD), shows a meta-analysis published in BMJ.

Vlado Perkovic (George Institute for Global Health, Sydney, Australia) and colleagues from the Blood Pressure Lowering Treatment Trialists’ Collaboration obtained individual patient data from 23 randomized, controlled trials and summary data from an additional three. The data included 30,295 patients with CKD and 121,995 without.

Overall, they found that patients with CKD had a 17% reduction in the risk for major cardiovascular events with each 5 mmHg reduction in systolic blood pressure.

“These analyses… provide compelling evidence for the cardiovascular benefits of reduction in blood pressure in people with stage 1–3 chronic kidney disease,” say the researchers.

Patients without CKD had an identical 17% risk reduction, but Perkovic et al note that “individuals with chronic kidney disease stood to gain much larger absolute benefits because their baseline risk was much higher.”

They calculate that, over a 4-year period, blood pressure treatment prevented 28 events per 1000 patients with CKD, compared with 19 per 1000 patients without.

Some studies have suggested that CKD patients derive particular benefit from specific classes of antihypertensive agent, but the researchers found no differences between drug classes after accounting for the degree of blood pressure reduction. So although some drugs produced a larger fall in blood pressure than others, the reduction in cardiovascular risk per 5 mmHg decrease in systolic blood pressure was the same irrespective of the antihypertensive used.

This suggests “that the cardiovascular benefits of lowering blood pressure in people with chronic kidney disease are more dependent on the blood pressure lowering effect achieved than on the agent selected,” say the researchers.

They conclude: “These findings should help to guide decision making for many physicians and their patients, given the absence of clear evidence to date supporting recommendations (for particular drug classes) to reduce the cardiovascular risk among people with early stage chronic kidney disease.”

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