Blood pressure lowering and major cardiovascular events in people with and without chronic kidney disease: meta-analysis of randomised controlled trials

Objective To define the cardiovascular effects of lowering blood pressure in people with chronic kidney disease.Design Collaborative prospective meta-analysis of randomised trials.Data sources and eligibility Participating randomised trials of drugs to lower blood pressure compared with placebo or e...

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Bibliographic Details
Published in:BMJ (Online) 2013-10, Vol.347 (7929), p.12-12
Main Authors: Ninomiya, T, Perkovic, V, Turnbull, F, Neal, B, Barzi, F, Cass, A, Baigent, C, Chalmers, J, Li, N, Woodward, M, MacMahon, S
Format: Article
Language:English
Subjects:
Angiotensin
Antagonists
Antihypertensive Agents - therapeutic use
Blood pressure
Blood Pressure - drug effects
Calcium antagonists
Cardiovascular disease
Cardiovascular diseases
Cardiovascular Diseases - etiology
Cardiovascular Diseases - physiopathology
Cardiovascular Diseases - prevention & control
Cerebral infarction
Clinical trials
Collaboration
Diuretics
Epidermal growth factor receptors
Evidence-based medicine
Experimentation
Glomerular filtration rate
Glomerular Filtration Rate - drug effects
Glomerular Filtration Rate - physiology
Heart diseases
Humans
Kidney diseases
Kidney transplantation
Medical research
Meta-analysis
Mortality
Myocardial infarction
Peptidyl-dipeptidase A
Randomized Controlled Trials as Topic
Renal Insufficiency, Chronic - complications
Renal Insufficiency, Chronic - physiopathology
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Summary:Objective To define the cardiovascular effects of lowering blood pressure in people with chronic kidney disease.Design Collaborative prospective meta-analysis of randomised trials.Data sources and eligibility Participating randomised trials of drugs to lower blood pressure compared with placebo or each other or that compare different blood pressure targets, with at least 1000 patient years of follow-up per arm.Main outcome measures Major cardiovascular events (stroke, myocardial infarction, heart failure, or cardiovascular death) in composite and individually and all cause death.Participants 26 trials (152 290 participants), including 30 295 individuals with reduced estimated glomerular filtration rate (eGFR), which was defined as eGFR 0.60 for homogeneity).Conclusions Blood pressure lowering is an effective strategy for preventing cardiovascular events among people with moderately reduced eGFR. There is little evidence from these overviews to support the preferential choice of particular drug classes for the prevention of cardiovascular events in chronic kidney disease.
ISSN:0959-8138
1756-1833
0959-8146
1756-1833
DOI:10.1136/bmj.f5680