Data from a new Lancet study suggests that patients with chronic kidney disease (CKD) might get similar cardiovascular protection from blood pressure drugs as the general population, giving physicians some certainty about how to approach BP in these patients.
- CKD patients are often underrepresented in trials exploring the CV benefits of antihypertensives because of safety concerns.
- That lack of data ultimately forces doctors to make treatment decisions using data from patients with normal kidney function, despite treating patients with extensive damage.
Constructing a massive meta-analysis, researchers examined 285k patients to see how BP lowering (using five antihypertensive classes) impacted CVD outcomes, finding that…
- A 5 mmHg reduction in systolic BP slashed a patient’s CVD risk, regardless of CKD status, over a median follow-up of 4.4 years.
- CKD and non-CKD patients saw a similar CVD risk decrease (-9% vs. -10%).
- The risk decrease from BP lowering came in at between -15% and -8% for all CKD stages, with stage 5 CKD patients seeing the least benefit.
- The effects of each of the five antihypertensive classes (ACEs, ARBs, BB, CCBs and thiazide) didn’t meaningfully differ by CKD status or stage.
That said, there was one patient group that was the exception – those with both CKD and diabetes.
- These patients saw much smaller cardiovascular benefits (HR: 0.96) compared to those with just CKD (HR: 0.88).
One important caveat is that the study didn’t track the antihypertensive side effects, including kidney impacts.
- For example, BP management slows CKD progression, but long-term antihypertensive use can cause its own renal issues by inducing hyperkalemia and lowering eGFR.
The Takeaway
Cardiologists see heart patients with CKD pretty often, so this study gives some much needed data for how BP management impacts CVD risk in patients whose kidneys are a co-morbidity. It also serves as a strong jumping off point for future studies on long-term hypertensive use in this patient population.
