A study led by Stanford University School of Medicine reveals that lowering blood pressure (BP) aggressively in people with chronic kidney disease (CKD) offers notable heart health benefits but also increases the risk of serious side effects.
The findings, published in JAMA Network Open, provide valuable insights for tailoring treatments in this high-risk group.
The research builds on the Systolic Blood Pressure Intervention Trial (SPRINT), a large randomized study involving over 9,000 participants. SPRINT demonstrated that keeping systolic BP below 120 mm Hg, compared to the standard target of under 140 mm Hg, significantly reduced cardiovascular events, deaths, and even mild cognitive impairment.
However, the study wasn’t specifically designed for CKD patients, raising questions about whether its findings apply to them, particularly those with advanced disease or multiple health issues.
To address this, researchers analyzed data from two major healthcare systems: the Veterans Health Administration (VHA) and Kaiser Permanente of Southern California (KPSC). This real-world study included 85,938 VHA patients and 13,983 KPSC patients, both with CKD.
The populations differed from the original SPRINT group by being older, having more advanced CKD, and experiencing higher rates of conditions like albuminuria (a marker of kidney damage). They also had lower rates of preexisting cardiovascular disease compared to the SPRINT participants.
The study confirmed that intensive BP control is linked to significant reductions in cardiovascular events and deaths in CKD patients. For the VHA cohort, cardiovascular events decreased by 5.1% over four years, while the KPSC group saw a 3.0% reduction.
These results suggest that lowering BP aggressively can have life-saving benefits, even in older, more medically complex populations.
However, the approach also carries risks. Patients in both cohorts experienced higher rates of adverse events, such as acute kidney injury and falls. In the VHA population, adverse events increased by 1.3%, while in the KPSC group, the increase was 3.1%.
Among those with advanced CKD, the treatment showed even greater cardiovascular benefits but came with heightened risks for complications like heart failure, acute coronary syndrome, and dementia.
The findings suggest that while intensive BP control can help prevent heart-related complications and reduce deaths, it may not be suitable for all CKD patients. Side effects like acute kidney injury or falls can have serious consequences, particularly for those who are frail or have advanced kidney disease.
This study reinforces the need for individualized treatment strategies. Healthcare providers should work closely with CKD patients to weigh the benefits and risks of aggressive BP management.
Shared decision-making, which involves discussing treatment options and potential side effects with patients, is essential to ensure that care aligns with each person’s needs and preferences.
Overall, while intensive BP control offers significant benefits for CKD patients, it is not a one-size-fits-all solution. The approach should be carefully tailored, especially for those with advanced disease or other complicating factors.
These findings highlight the importance of balancing cardiovascular protection with the risks of adverse events to achieve the best outcomes for patients with CKD.
If you care about kidney health, please read studies about how to protect your kidneys from diabetes, and drinking coffee could help reduce risk of kidney injury.
For more information about kidney health, please see recent studies about foods that may prevent recurrence of kidney stones, and eating nuts linked to lower risk of chronic kidney disease and death.
The research findings can be found in JAMA Network Open.
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