Blood Pressure Lowering and Risk of Mortality in Chronic Kidney Disease: A Meta2 Analysis of Randomized Controlled Trials

Importance: Trials in hypertensive patients demonstrate that intensive blood pressure (BP) lowering reduces risk of cardiovascular disease (CVD) and all-cause mortality, but may increase risk of chronic kidney disease (CKD) incidence and progression. Whether intensive BP lowering is associated with a mortality benefit in patients with prevalent CKD remains unknown. Objective: We conducted a meta-analysis of Randomized controlled trials (RCTs) to determine if more intensive, compared with a less intensive, BP control is associated with reduced mortality risk in persons with CKD stages 3-5. Data Sources: Ovid Medline, Cochrane Library, Embase, Pubmed, Science Citation Index, Google Scholar, and ClinicalTrials.gov electronic databases. Study Selection: All RCTs that compared two defined BP targets (either active treatment vs.placebo or no treatment, or intensive vs. less intensive BP control) and enrolled adult (≥18years) persons with CKD stages 3-5 (estimated glomerular filtration rate (eGFR)