Ahmed Anas E, Halawany Khaled W, Alyahyawi Faizah S, Khormi Abdullah H, AlQibti Hussain M, Saifain Othman M, Alqarni Talal M, Alqurashi Jana S, Alabdali Rose M, Alowaimer Shoog T
Community Medicine, Jazan University, Jazan, SAU.
Pharmacy, Armed Forces Hospital, Wadi Al Dawasir, Riyadh, SAU.
Cureus. 2025 Jun 17;17(6):e86230. doi: 10.7759/cureus.86230. eCollection 2025 Jun.
Cardiovascular disease remains the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), with hypertension, common in this population, contributing significantly to vascular damage and cardiovascular risk. This systematic review evaluates the impact of blood pressure (BP) control on cardiovascular outcomes in individuals with CKD. A comprehensive search of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science up to May 5, 2025, identified randomized controlled trials (RCTs) and prospective comparative studies assessing BP interventions and cardiovascular outcomes in CKD populations. Methodological quality was appraised using the Modified Downs and Black checklist. Of the 11,606 studies screened, 10 met the inclusion criteria. Interventions included intensive BP targets, renin-angiotensin-aldosterone system (RAAS) blockers, sodium-glucose cotransporter-2 (SGLT2) inhibitors, and antioxidant therapies. Most studies reported significant reductions in cardiovascular events, particularly with intensive BP control, though risks such as acute kidney injury (AKI) and hyperkalemia were noted. Nutraceuticals showed potential for anti-inflammatory and BP-lowering benefits. Overall, the methodological quality was high, with most studies rated as good to excellent. Targeted BP control appears to significantly reduce cardiovascular risk in CKD patients; however, individualized treatment strategies are essential to minimize adverse renal outcomes. While the evidence supports the cardiovascular benefits of BP management in this population, further research is needed to optimize intervention strategies and define safety thresholds.
心血管疾病仍然是慢性肾脏病（CKD）患者发病和死亡的主要原因，高血压在该人群中很常见，对血管损伤和心血管风险有显著影响。本系统评价评估了血压（BP）控制对CKD患者心血管结局的影响。截至2025年5月5日，对PubMed、Cochrane对照试验中央注册库（CENTRAL）、Scopus和科学网进行全面检索，确定了评估CKD人群中血压干预措施和心血管结局的随机对照试验（RCT）和前瞻性比较研究。使用改良的唐斯和布莱克检查表评估方法学质量。在筛选的11606项研究中，有10项符合纳入标准。干预措施包括强化血压目标、肾素-血管紧张素-醛固酮系统（RAAS）阻滞剂、钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂和抗氧化疗法。大多数研究报告心血管事件显著减少，尤其是强化血压控制时，不过也注意到急性肾损伤（AKI）和高钾血症等风险。营养保健品显示出抗炎和降低血压的潜在益处。总体而言，方法学质量较高，大多数研究被评为良好至优秀。有针对性的血压控制似乎能显著降低CKD患者的心血管风险；然而，个体化治疗策略对于将不良肾脏结局降至最低至关重要。虽然证据支持该人群中血压管理对心血管的益处，但仍需要进一步研究以优化干预策略并确定安全阈值。
