Impact of intensive blood pressure control on kidney outcomes

Hypertension has long been recognized as a modifiable risk factor for cardiovascular events. However, the role of intensive blood pressure (BP) control in preventing kidney disease progression continues to be debated. This review will provide a brief update on the evidence in support of or against the intensive control of BP on kidney outcomes in patient with chronic kidney disease (CKD), focusing particularly on trial-grade evidence. Recently, three large trials conducted in China compared the effects of intensive BP control in adults with cardiovascular risk factors. All three trials demonstrated that intensive BP control confers cardiovascular benefits, but mixed results were noted in terms of the risk of adverse kidney outcomes. In individual-level meta-analyses of six trials of different BP control strategies in patients with CKD, intensive BP control appeared to reduce the risk of kidney replacement therapy in those with CKD stage 4-5, but not in patients with CKD stage 3. Most guidelines continue to recommend a systolic BP target of 120-130 mmHg for patients with CKD given the cardiovascular benefits observed in trials of intensive BP control, though there are some signals of potential risks to the kidney with this BP treatment strategy.