A recent study conducted by Guyu Zeng and colleagues and published in The Lancet highlighted that lowering blood pressure (BP) reduces major cardiovascular events in people with chronic kidney disease (CKD), with benefits comparable to those seen in people without CKD. The effect was consistent across all CKD stages, including advanced stages 4–5, and did not vary by baseline BP or proteinuria. The cardiovascular benefit was also similar across antihypertensive drug classes. One important exception was in CKD patients with diabetes, who experienced a smaller relative risk reduction. GlobalData believes that this meta-analysis is important because it includes many patients with more advanced kidney impairment—a group that has been underrepresented in earlier trials and meta-analyses.
Using data from 46 randomised trials and 285,124 participants, researchers found that a 5mmHg reduction in systolic BP lowered major cardiovascular events in people with CKD to a similar degree as in those without CKD, with no meaningful loss of benefit as kidney function declined. The main clinical implication is that BP-lowering therapy should no longer be viewed as only marginally useful in CKD or reserved for patients with a clearly high baseline BP. The study found a consistent benefit across CKD stages 1–5, across baseline blood-pressure categories, and regardless of proteinuria status, including in advanced CKD with a mean estimated glomerular filtration rate around 25mL/min per 1.73m². This is significant because clinicians have often been cautious in later-stage CKD, partly out of concern that intensive treatment might offer little cardiovascular gain or create harm. This analysis supports a more proactive stance when the goal is cardiovascular risk reduction.
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The meta-analysis is significant because it strengthens the demand for established antihypertensive therapies in CKD by showing that they remain effective across CKD stages, including in advanced disease. It may also support the broader use of BP-lowering treatment in high-risk CKD patients, which could expand prescribing volumes in a large and growing market.
