Blood pressure trial intervention shows mixed outcomes in chronic kidney disease patients

Stanford University School of Medicine–led researchers have found that intensive blood pressure (BP) control produces cardiovascular benefits and increases the risk of adverse events in people with chronic kidney disease (CKD).

The work is published in the journal JAMA Network Open.

This approach was initially studied in the Systolic Blood Pressure Intervention Trial (SPRINT), a randomized trial with over 9,000 participants. The intervention demonstrated reduced cardiovascular events, mortality, and reduced rates of mild cognitive impairment.

Intensive BP control consisted of treatment with antihypertensive medications to maintain a systolic BP below 120 mm Hg, as opposed to

SPRINT’s trial design was not specifically about chronic kidney disease (CKD), although it included a subgroup of participants with CKD and reported findings for this group. SPRINT’s CKD findings have faced scrutiny for their generalizability and for those with more advanced CKD because the cohort had fewer older adults and comorbidities than seen in typical patient populations.

In the study titled “SPRINT Treatment Among Adults With Chronic Kidney Disease From Two Large Health Care Systems,” SPRINT was evaluated in two large health care systems, Veterans Health Administration (VHA) and Kaiser Permanente of Southern California (KPSC), to see whether similar outcomes appeared in routine clinical populations.

The study included 85,938 VHA patients (75.7 years, 95% male) and 13,983 KPSC patients (77.4 years, 38.4% male). While the eligibility criteria were not modified, the VHA and KPSC populations were inherently different from the SPRINT population due to demographic and clinical characteristics.

VHA and KPSC patients were older on average and included a higher percentage of advanced CKD cases. They also had higher rates of statin use and albuminuria but lower rates of preexisting cardiovascular disease compared to the original SPRINT participants.

Findings revealed that intensive BP control was associated with significant reductions in cardiovascular events and all-cause mortality in both VHA and KPSC populations.

Absolute risk reductions were more prominent in the VHA cohort, with a 5.1% decrease in cardiovascular events at four years compared to a 3.0% reduction in the KPSC group.

Adverse event risks, including acute kidney injury and falls, increased by 1.3% in the VHA population and 3.1% in KPSC. Effects on cognitive impairment and CKD progression were not consistent between trial and target populations.

In patients with advanced CKD, intensive BP control resulted in more significant cardiovascular and mortality benefits but was also linked to heightened risks of heart failure, acute coronary syndrome, dementia, and acute kidney injury.

While the results support the applicability of SPRINT findings to broader CKD populations, the increased adverse event risks, especially in patients with advanced CKD, underscore the importance of individualized treatment strategies and shared decision-making with patients.

© 2025 Science X Network

Stanford University School of Medicine–led researchers have found that intensive blood pressure (BP) control produces cardiovascular benefits and increases the risk of adverse events in people with chronic kidney disease (CKD).

The work is published in the journal JAMA Network Open.

This approach was initially studied in the Systolic Blood Pressure Intervention Trial (SPRINT), a randomized trial with over 9,000 participants. The intervention demonstrated reduced cardiovascular events, mortality, and reduced rates of mild cognitive impairment.

Intensive BP control consisted of treatment with antihypertensive medications to maintain a systolic BP below 120 mm Hg, as opposed to

SPRINT’s trial design was not specifically about chronic kidney disease (CKD), although it included a subgroup of participants with CKD and reported findings for this group. SPRINT’s CKD findings have faced scrutiny for their generalizability and for those with more advanced CKD because the cohort had fewer older adults and comorbidities than seen in typical patient populations.

In the study titled “SPRINT Treatment Among Adults With Chronic Kidney Disease From Two Large Health Care Systems,” SPRINT was evaluated in two large health care systems, Veterans Health Administration (VHA) and Kaiser Permanente of Southern California (KPSC), to see whether similar outcomes appeared in routine clinical populations.

The study included 85,938 VHA patients (75.7 years, 95% male) and 13,983 KPSC patients (77.4 years, 38.4% male). While the eligibility criteria were not modified, the VHA and KPSC populations were inherently different from the SPRINT population due to demographic and clinical characteristics.

VHA and KPSC patients were older on average and included a higher percentage of advanced CKD cases. They also had higher rates of statin use and albuminuria but lower rates of preexisting cardiovascular disease compared to the original SPRINT participants.

Findings revealed that intensive BP control was associated with significant reductions in cardiovascular events and all-cause mortality in both VHA and KPSC populations.

Absolute risk reductions were more prominent in the VHA cohort, with a 5.1% decrease in cardiovascular events at four years compared to a 3.0% reduction in the KPSC group.

Adverse event risks, including acute kidney injury and falls, increased by 1.3% in the VHA population and 3.1% in KPSC. Effects on cognitive impairment and CKD progression were not consistent between trial and target populations.

In patients with advanced CKD, intensive BP control resulted in more significant cardiovascular and mortality benefits but was also linked to heightened risks of heart failure, acute coronary syndrome, dementia, and acute kidney injury.

While the results support the applicability of SPRINT findings to broader CKD populations, the increased adverse event risks, especially in patients with advanced CKD, underscore the importance of individualized treatment strategies and shared decision-making with patients.

© 2025 Science X Network