Lowering Blood Pressure to Lower the Risk of Cardiovascular Events in CKD

Abstract

(N530,295) had an estimated glomerular filtration rate (eGFR; calculated using the MDRD [Modification of Diet in Renal Disease] Study equation) , 60 mL/min/ 1.73 m 2 . Of these more than 30,000 individuals, only 439 (0.3% of total cohort) had eGFRs , 30 mL/min/ 1.73 m 2 at baseline. As such, results should be considered generalizable to only patients with CKD stage 3, ratherthantoallpatientswithCKDirrespectiveofstage. The primary outcome of the meta-analysis was major cardiovascular events, defined as the first episode of stroke, coronary heart disease, heart failure, and cardiovascular death. Active treatment with an angiotensin-converting enzyme (ACE) inhibitor compared with placebo resulted in a 19% (95% confidence interval [CI], 10%-27%) lower risk of the primary outcome, whereas calcium channel antagonists compared with placebo (3 studies; N 5 6,107) led to a 28% (95% CI, 11%-42%) lower risk. After accounting for the larger reduction in blood pressure in trials that used calcium channel antagonists, the relative risk reduction for ACE inhibitors versus placebo (hazard ratio [HR], 0.83; 95% CI, 0.79-0.87) was nearly identical to the relative risk reduction for calcium channel antagonists versus placebo (HR, 0.84; 95% CI, 0.75-0.94). When the efficacy of different medication classes was compared head to head, no significant differences were observed for ACE inhibitors versus calcium channel antagonists or for comparisons of either of these 2 medication classes versus diuretic- or b-blocker–based regimens. Taken together, these results suggest that among the classes of medications included in this meta-analysis, no one class of antihypertensive agent is superior to any other for preventing cardiovascular events.