Patients with chronic kidney disease (CKD) enjoyed the same reduction in cardiovascular risk from lowering systolic blood pressure (SBP) as those without CKD, and this finding held across all CKD stages, BP thresholds, proteinuria status and antihypertensive class, according to research published April 25 in The Lancet.

Guyu Zeng, MD, and colleagues, on behalf of the Blood Pressure Lowering Treatment Trialists' Collaboration, conducted a one-stage meta-analysis using individual-participant data from 285,124 eligible patients (41% women) in 46 randomized trials of BP lowering.

Of the participants, 21% had CKD (24% ≥stage 3b). Those with CKD were more likely to be female, less likely to smoke, and were older with higher baseline SBP and greater prevalence of cardiovascular comorbidities. The prevalence of diabetes was 31% among both those with and without CKD.

Results showed that during a median follow-up of 4.4 years, 13% of 284,134 patients experienced the primary outcome, a composite of fatal or nonfatal stroke or other cerebrovascular disease, fatal or nonfatal ischemic heart disease, or heart failure leading to death or hospitalization.

Researchers found that each 5 mm Hg reduction in SBP was associated with a 10% reduction in cardiovascular risk in participants with and without CKD (hazard ratio [HR], 0.91 vs. HR, 0.90; p_int >0.99). Among those with CKD, this risk reduction was consistent across all CKD stages, proteinuria status and BP categories down to <120/70 mm Hg. This effect was also consistent across all antihypertensive drug classes.

Importantly, the relative risk reduction with BP lowering was attenuated in the presence of diabetes, vs. no diabetes, in participants with CKD (HR, 0.96 vs. HR, 0.88; p_int =0.044).

"To mitigate risk in this subgroup [with diabetes], therapeutic regimens might require the integration of antihypertensives with agents such as SGLT2 inhibitors or GLP-1 receptor agonists, which provide robust cardiorenal protection and enhance [glycemic] regulation," write Zeng, et al.

"The heterogeneity observed in [this] study, particularly among participants with coexisting diabetes, suggests that an overall benefit does not necessarily imply uniform benefit across all patients," write Yingxian Sun, MD, and Xiaofan Guo, MD, in an accompanying editorial comment. "Models that estimate individual treatment effects, potentially supported by advanced predictive methods including artificial intelligence and large language models, could help refine precision strategies for blood-pressure control in people with CKD."