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

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

In a benefit-harm trade-off analysis of 2,012 participants with CKD, investigators found that when predicting individualized treatment effects for multiple outcomesand simulating preferences for participants who view the benefits of intensive blood pressure lowering (reductions in death, cardiovascular events, and cognitive impairment) as much more important than treatment-related harms (such as emergency room visits or hospitalizations for acute kidney injury and fainting), 100% had a positive net benefit favoring intensive blood pressure lowering. When simulating benefits and harms to have similar, intermediate importance, 9 out of 10 still had a positive net benefit.

Compared with people with earlier-stage CKD (estimated glomerular filtration rate(45–59 ml/min/1.73m2), people with more advanced CKD (20–44 ml/min/1.73m2) experienced more treatment-related harms from a lower systolic blood pressure goal; however, they also had larger benefits, which resulted in the more advanced CKD group having greater net benefits. The findings, which are consistent with KDIGO Guidelines that recommend a systolic blood pressure target of <120 mm Hg for adults with hypertension and CKD, could help patients and care partnersovercome therapeutic inertia that commonly occurs with intensifying blood pressure control in adults with CKD.

This study demonstrates that evidence about blood pressure targets from SPRINT can be personalized to adults with hypertension and CKD by using each individual's estimated risks and preferences for multiple outcomes related to bloodpressure lowering, which could help facilitate shared decision-making conversations."

Alan Vera, Medical Student, University of California Davis