Largest study to date across the full CKD spectrum
The study, published in The Lancet, analysed data from 285,124 participants across 46 randomised controlled trials, including more than 59,000 people with CKD making it the largest randomised evidence base to date examining cardiovascular outcomes in people with CKD.
People with CKD are at particularly high risk of cardiovascular disease but have historically been underrepresented in clinical trials, leaving uncertainty about the benefits of blood pressure treatment in this group.
Consistent benefits across all stages of kidney disease
Researchers found that a 5 mm Hg reduction in systolic blood pressure was associated with a roughly 10% reduction in the relative risk of major cardiovascular events, including stroke, heart attack, and heart failure.
Importantly, this benefit was consistent:
- Across all stages of CKD, including patients with severely reduced kidney function (stages 4–5), a group historically underrepresented in trials
- Across different baseline blood pressure levels
- Regardless of the presence of proteinuria
Reduced benefit in people with both CKD and diabetes
The study also identified an important difference in people with both CKD and diabetes. In this group, the relative reduction in cardiovascular risk from blood pressure lowering was smaller compared with those without diabetes.
This highlights the need for tailored treatment strategies in this higher-risk population.
Implications for treatment and guidelines
The findings suggest that blood pressure-lowering treatment can be beneficial for cardiovascular risk reduction in people with CKD at any stage of disease, and across a wide range of baseline blood pressure levels.
The results also show that different classes of all five major antihypertensive drug classes showed similar cardiovascular benefits in people with CKD as in the general population, giving clinicians flexibility in treatment choices.
Supporting more confident clinical decision-making
By providing robust evidence across the full spectrum of CKD, the study helps address longstanding gaps in clinical evidence and supports more consistent, evidence-based management of cardiovascular risk in this high-risk group.
QUotes
“This study settles a long-standing question: blood pressure lowering provides the same cardiovascular protection in people with kidney disease as in those without - across every stage of the disease, every blood pressure level we examined, and regardless of whether proteinuria is present. Crucially, we now have the largest body of randomised evidence ever assembled for patients with advanced kidney disease, a group that has been systematically excluded from trials despite facing the highest cardiovascular risk. Our finding that this benefit is attenuated when diabetes coexists points to the need for combination strategies that go beyond blood pressure control alone.” - Dr Milad Nazarzadeh, corresponding author and British Heart Foundation Research Fellow at the University of Oxford
“These findings carry direct implications for clinical practice. Clinicians can now confidently recommend blood pressure-lowering therapy to patients at any stage of kidney disease, knowing that the cardiovascular benefits are consistent. And because no single drug class stands out, there is genuine flexibility to tailor treatment to the individual patient.” - Professor Kazem Rahimi, co-investigator and Director of the Deep Medicine programme at the University of Oxford, and Chair of the BPLTTC collaboration