Using estimated risks and preferences to justify intensive BP control in patients with CKD

An analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) shows that almost all adults with chronic kidney disease (CKD) will have benefits that outweigh the harm from a systolic blood pressure target of <120 mm Hg compared with a target of <140 mm Hg. The findings will be presented at ASN Kidney Week 2025, November 5–9.

In a benefit-harm trade-off analysis of 2,012 participants with CKD, researchers found that when predicting individualized treatment effects for multiple outcomes and simulating preferences for participants who see the benefits of a sharp blood pressure reduction (reductions in death, cardiovascular events, and cognitive impairment) far more important than kidney emergency visits or hospital harm fainting), 100% had a positive net benefit favoring intensive lowering of blood pressure. When simulating benefits and harms of similar, intermediate significance, 9 out of 10 still had a positive net benefit.

Compared with subjects with early-stage CKD (estimated glomerular filtration rate (45–59 ml/min/1.73m2), subjects with more advanced CKD (20–44 ml/min/1.73m2) experienced more treatment-related harm from a lower systolic blood pressure goal; however, they also had greater benefits than the CK group. The findings, which are consistent with KDIGO guidelines recommending a systolic blood pressure goal of <120 mm Hg for adults with hypertension and CKD could help patients and care partners overcome the therapeutic inertia that commonly occurs with intensive blood pressure control in adults with CKD.

This study shows that data on blood pressure goals from SPRINT can be personalized to adults with hypertension and CKD using each individual’s estimated risks and preferences for multiple outcomes associated with blood pressure reduction, which could help facilitate shared decision-making discussions.”

Alan Vera, Medical Student, University of California Davis