Using risk and preference estimates to justify intensive BP control in patients with CKD

Analysis of the SPRINT (Systolic Blood Pressure Intervention Trial) trial indicates that almost all adults with chronic kidney disease (CKD) would benefit from outweighing the harms of a systolic blood pressure target of <120 mm Hg compared with a target of <140 mm Hg. The results will be presented during ASN Kidney Week 2025 on November 5-9.

In a benefit-harm analysis of 2,012 participants with CKD, researchers found that when predicting individualized treatment effects on multiple outcomes and simulating the preferences of participants for whom the benefits of intensive blood pressure lowering (reductions in deaths, cardiovascular complications, and cognitive impairment) are much more important than treatment-related harms (such as emergency room visits or hospitalizations for acute kidney injury and syncope), 100% experienced a positive net benefit favoring intensive lowering of blood pressure. By simulating that benefits and harms have similar, indirect importance, 9 out of 10 still had a positive net benefit.

Compared with those with early-stage CKD (estimated glomerular filtration rate (45–59 mL/min/1.73 m2), those with more advanced CKD (20–44 mL/min/1.73 m2) experienced more treatment-related harm as a result of the lower systolic blood pressure target, but also achieved greater benefits, resulting in the more advanced CKD group benefiting more net. The results are consistent with the KDIGO guideline, which recommends a target systolic blood pressure of <120 mm Hg in adults with hypertension and CKD may help patients and treatment partners overcome the therapeutic inertia that often occurs when blood pressure control is increased in adults with CKD.

This study demonstrates that SPRINT blood pressure target data can be personalized for adults with hypertension and CKD by using each person’s estimated risk and preferences for multiple blood pressure lowering outcomes, which may facilitate shared decision-making conversations.”

Alan Vera, a medical student at the University of California, Davis