Tada Kazuhiro, Fujiwara Akira, Sugano Naoki, Hayashi Kaori, Sakima Atsushi, Takami Yoichi, Masutani Kosuke, Arima Hisatomi, Arima Shuji, Nakagawa Naoki
Division of Nephrology and Rheumatology, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
Department of Nephrology and Hypertension, Yokohama City University Medical Center, Yokohama, Japan.
Hypertens Res. 2025 Jun 20. doi: 10.1038/s41440-025-02262-4.
Many studies have investigated optimal blood pressure (BP) targets in patients with chronic kidney disease (CKD); however, no consensus has been reached. We therefore conducted a systematic review and meta-analysis, including the latest randomized controlled trials (RCTs). We searched MEDLINE, the Cochrane Library, and Ichushi Web for publications up to 13 June 2024, supplemented by hand searches. We included RCTs comparing the benefits and risks of more intensive (target BP: <130/80 mmHg) versus less intensive BP control (target BP: 130-149/80-89 mmHg or usual care) in patients with CKD aged ≥18 years, regardless of diabetes status. Primary outcomes were all-cause mortality and cardiovascular events. Secondary outcomes included renal events, including 50% reduction in estimated glomerular filtration rate (eGFR)/GFR, and end-stage kidney disease (ESKD). We calculated the risk ratio (RR) and variance, and obtained summary estimates of the effects with 95% confidence intervals (CIs) using a random-effects model with inverse variance weighting. Our meta-analysis included nine RCTs. More intensive BP control tended to reduce all-cause mortality (RR = 0.81; 95% CI 0.65-1.00; p = 0.051) and cardiovascular events (RR = 0.89; 95% CI 0.77-1.03; p = 0.13), but the differences were not significant. More intensive BP control did not increase the risk of serious renal events, including 50% reduction in eGFR/GFR (RR = 0.95; 95% CI 0.74-1.22; p = 0.69) or progression to ESKD (RR = 0.92; 95% CI 0.75-1.14; p = 0.45). These findings suggest that intensive BP control targeting <130/80 mmHg may reduce the risk of all-cause mortality and cardiovascular events in patients with CKD, without increasing the risk of serious renal events. This meta-analysis of nine RCTs in patients with CKD found that more intensive BP control tended to reduce all-cause mortality and CVD events compared with less intensive control, without increasing serious kidney events, including 50% eGFR/GFR reduction, or ESKD.
许多研究探讨了慢性肾脏病（CKD）患者的最佳血压（BP）目标；然而，尚未达成共识。因此，我们进行了一项系统评价和荟萃分析，纳入了最新的随机对照试验（RCT）。我们检索了MEDLINE、Cochrane图书馆和Ichushi Web，查找截至2024年6月13日的出版物，并辅以手工检索。我们纳入了比较强化血压控制（目标血压：<130/80 mmHg）与非强化血压控制（目标血压：130 - 149/80 - 89 mmHg或常规治疗）对≥18岁CKD患者的益处和风险的RCT，无论其糖尿病状态如何。主要结局为全因死亡率和心血管事件。次要结局包括肾脏事件，即估计肾小球滤过率（eGFR）/肾小球滤过率（GFR）降低50%，以及终末期肾病（ESKD）。我们计算了风险比（RR）和方差，并使用具有逆方差加权的随机效应模型获得了效应的汇总估计值及其95%置信区间（CI）。我们的荟萃分析纳入了9项RCT。强化血压控制倾向于降低全因死亡率（RR = 0.81；95% CI 0.65 - 1.00；p = 0.051）和心血管事件（RR = 0.89；95% CI 0.77 - 1.03；p = 0.13），但差异不显著。强化血压控制并未增加严重肾脏事件的风险，包括eGFR/GFR降低50%（RR = 0.95；95% CI 0.74 - 1.22；p = 0.69）或进展为ESKD（RR = 0.92；95% CI 0.75 - 1.14；p = 0.45）。这些发现表明，将目标血压控制在<130/80 mmHg的强化血压控制可能会降低CKD患者的全因死亡率和心血管事件风险，而不会增加严重肾脏事件的风险。这项对9项CKD患者RCT的荟萃分析发现，与非强化控制相比，强化血压控制倾向于降低全因死亡率和心血管疾病事件，且不会增加严重肾脏事件的风险，包括eGFR/GFR降低50%或ESKD。
