Abstract: FR-OR123

Blood Pressure Lowering and Risk of Mortality in CKD: A Meta-Analysis of Randomized Controlled Trials

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 304 CKD: Epidemiology, Outcomes - Non-Cardiovascular

Authors

  • Malhotra, Rakesh, UCSD, San Diego, California, United States
  • Coleman, Ruth L, University of Oxford, Oxford, United Kingdom
  • Rury, Holman, University of Oxford, Oxford, United Kingdom
  • Zanchetti, Alberto, Istituto Auxologico Italiano, University of Milan, Milan, Italy
  • Peters, Ruth, Imperial College London , London, United Kingdom
  • Beckett, Nigel, Guys and St Thomas'' NHS Foundation Trust, London, United Kingdom
  • Staessen, Jan A., Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, Department of Cardiovascular Diseases, University of Leuven, Leuven, Belgium
  • Ix, Joachim H., UCSD, San Diego, California, United States
  • Nguyen, Hoang Anh, UCSD Department of Nephrology and Hypertension, San Diego, California, United States
  • Benavente, Oscar, University of British Columbia, Vancouver, British Columbia, Canada
  • Mete, Mihriye, Medstar Health Research Institute, Hyattsville, Maryland, United States
  • Mant, Jonathan, University of Cambridge, Cambridge, United Kingdom
  • Odden, Michelle, Oregon State University, Corvallis, Oregon, United States
  • Peralta, Carmen A., University of California San Francisco/SFVAMC, San Francisco, California, United States
  • Cheung, Alfred K., University of Utah, Salt Lake City, Utah, United States
  • Nadkarni, Girish N., Ichan School of Medicine, New York, New York, United States
Background

Trials in hypertensive patients demonstrate that intensive blood pressure (BP) lowering reduces CVD and mortality risk, but may increase risk of chronic kidney disease (CKD) progression. Whether intensive BP lowering is associated with a lower mortality in patients with prevalent CKD remains uncertain.

Methods

We conducted a meta-analysis of randomized controlled trials (RCTs) that enrolled patients with CKD stage 3-5 and determined whether randomization to more vs. less intensive BP control was associated with mortality. Ovid Medline, Cochrane Library, Embase, Pubmed, and ClinicalTrials.gov electronic databases were searched. All RCTs that compared two defined BP targets (either active treatment vs. placebo or no treatment, or intensive vs. less intensive BP control) and enrolled persons with CKD stages 3-5 exclusively or as CKD subgroup between January 1950 and June 2016 were included. The main outcome was mortality during the active phase of each trial.

Results

We identified 31 RCTs, among which we were able to extract the CKD subset mortality data in 19 trials. There were 1300 deaths among 15,861 participants with CKD. More vs. less-intensive BP control resulted in 14% lower risk of all-cause mortality (Odds Ratio (OR) 0.86; 95% CI 0.76- 0.96, p = 0.009) (Figure 1); a finding that was without significant heterogeneity (p=non-sig) across subgroups including type of treatment in the comparator arm (placebo vs. less intensive BP target), length of follow-up, presence of diabetes, baseline SBP, achieved SBP during the trial and degree of SBP differences across the treatment arms.

Conclusion

Randomization to more intensive BP control is associated with lower mortality risk among CKD trial participants.

Figure 1. Effect of Intensive BP Lowering on Risk of Mortality in Participants with CKD