Intensive BP Lowering Reduced Cardiovascular Risk but Increased eGFR Decline

A systematic review and meta-analysis of 27 studies involving 88,830 participants found that intensive blood pressure (BP) lowering reduced the risk of major cardiovascular events by 15% for every 10-mm Hg reduction in systolic BP, regardless of chronic kidney disease (CKD) status. The estimated absolute reduction was 4.3 cardiovascular events per 1,000 person-years in people with CKD and 2.7 in those without CKD. Intensive BP lowering did not significantly reduce or increase the risk of kidney failure, nor did it significantly affect the risk of sustained estimated glomerular filtration rate (eGFR) declines of 50% or 57%. However, it increased the risk of sustained eGFR declines of at least 30% and 40% by 42% and 47%, respectively. These findings suggest that intensive BP lowering reduces cardiovascular risk in adults with and without CKD. Because people with CKD have a higher baseline cardiovascular risk, their absolute benefit was at least as large as that of people without CKD. Therefore, intensive BP lowering should be recommended for both populations, with careful monitoring of kidney function. Source: https://jamanetwork.com/