A Meta-analysis on Standard and Intensive Blood Pressure Control in Patients with Chronic Kidney Disease (1st Place – Meta-Analysis)
Louie Alfred Shiu, MD, Nina Noreen Diansuy & Rosemarie Ramirez-Ragasa
Noemi Pestaño, MD, Felix Eduardo Punzalan, MD & Bernadette Tumanan-Mendoza, MD***
Background: Chronic kidney disease is a significant burden worldwide. The prevalence of chronic kidney disease (CKD) globally is 13.4%(11.7%-15.1%) for all stages. According to the NNHeS 2003 renal report, the prevalence of CKD in the Philippines is 2.6% in CKD Stages 3-5.15 Kidney disease is 9th in the top ten causes of mortality according to the 2012 Philipphine health statistics.17 High blood pressure is a major determinant of disease progression in diabetic and non diabetic chronic kidney disease.23 However, due to conflicting data regarding blood pressures goals, we sought to determine the effect of standard and intensive blood pressure control in all-cause mortality, cardiovascular event, renal failure, and end stage renal disease among patients with chronic kidney disease.
Objective: To evaluate the effectiveness of intensive blood pressure control in reducing mortality and morbidity among patients with chronic kidney disease.
Methodology: We obtained relevant trials from Pubmed and Cochrane trials. The search was restricted to studies conducted on human subjects. A review of reference list of the previous meta- analyses was also done. All prospective, randomized and clinical trials involving chronic kidney patients (CKD) with standard and intensive blood pressure control were included. Outcome measured were all cause mortality, cardiac events, end stage renal disease, and kidney injury. We obtained total of 1659 studies and ended with six studies through careful appraisal of the studies. Cochrane Review Manager Software version 5.3 was used in the analysis.
Results: The pooled analysis of the mortality rates, cardiovascular events, end stage renal disease, and kidney injury of patients with chronic kidney disease (CKD) showed no significant effect and no significant heterogeneity.
Authors’ conclusions: Intensive blood pressure control in patients with chronic kidney disease did not show significant effect on all-cause mortality, cardiovascular events, end stage renal disease and kidney injury. We recommend maintaining the current blood pressure targets of <140/90 mmHg for patients with chronic kidney disease. However, blood pressure goals in patients with chronic kidney disease must still be carefully deliberated and individualized by the attending physician taking note of the patient’s individual profile.
***Advisers/Consultants, Department of Internal Medicine Section of Cardiology