lower Blood pressure Targets Benefit Moast wiht Chronic Kidney Disease, new Research Shows
Nearly all adults living with chronic kidney disease (CKD) stand to benefit from more aggressive blood pressure management, according to a new analysis of the landmark Systolic blood Pressure Intervention Trial (SPRINT). the findings, to be presented at ASN Kidney Week 2025 November 5-9, suggest a systolic blood pressure target of less than 120 mm hg offers a notable advantage over the previously recommended target of less than 140 mm Hg.
The research, published in the Journal of the American Society of Nephrology, offers a compelling case for personalized medicine in hypertension and CKD treatment. Investigators conducted a benefit-harm trade-off analysis involving 2,012 CKD patients, simulating various patient preferences to determine the net benefit of intensive blood pressure lowering.
“This study demonstrates that evidence about blood pressure targets from SPRINT can be personalized to adults with hypertension and CKD by using each individualS estimated risks and preferences for multiple outcomes related to blood pressure lowering,” explained Alan Vera, a medical student at the University of California Davis and lead researcher on the project.
The analysis revealed striking results.When prioritizing the benefits of lower blood pressure – including reduced risk of death, cardiovascular events, and cognitive impairment – over potential harms like hospitalizations for acute kidney injury or fainting, a full 100% of participants experienced a positive net benefit from intensive blood pressure control. Even when benefits and harms were weighted equally, 90% of participants still showed a net benefit.
Did you know? – The SPRINT trial was halted early due to the clear benefits of intensive blood pressure control, even in older adults.
Interestingly, the study found that individuals with more advanced CKD (estimated glomerular filtration rate of 20-44 ml/min/1.73m2) experienced a greater net benefit than those with earlier-stage disease (45-59 ml/min/1.73m2). While advanced CKD patients experienced more treatment-related harms from lower blood pressure, they also experienced proportionally larger benefits.
These findings align with existing KDIGO Guidelines, which already recommend a systolic blood pressure target of less than 120 mm Hg for adults with both hypertension and CKD. Researchers believe this data could be instrumental in overcoming therapeutic inertia – the tendency to avoid intensifying blood pressure control – among clinicians treating patients with CKD.
Pro tip: – Regularly monitor kidney function (eGFR) and blood pressure when intensifying treatment.adjust medications as needed to minimize harm.
The study underscores the importance of shared decision-making between patients and healthcare providers, allowing for individualized treatment plans based on risk assessment and personal preferences. This personalized approach promises to optimize outcomes and improve the quality of life for millions living with CKD.
Journal reference: Vera, A. R., et al. (2025). Individualized Net Benefit of Intensive Blood Pressure Lowering Among Persons with CKD in SPRINT. Journal of the American Society of Nephrology. DOI: 10.1681/asn.20259y3vaxb9.
Reader question: – How might these findings impact current clinical practice regarding blood pressure management in CKD patients?
Why: The research aimed to personalize blood pressure targets for individuals with chronic kidney disease (CKD) and hypertension, building upon the findings of the SPRINT trial. It sought to determine the net benefit of intensive blood pressure lowering based on individual risk factors and preferences.
Who: The study involved 2,012 CKD patients who participated in the SPRINT trial. The lead researcher was Alan Vera, a medical student at the University of California Davis.The research was presented by investigators at ASN Kidney Week 20
