ArticleJAMA cardiology2026
Intensive vs Standard Blood Pressure Lowering in People With and Without Chronic Kidney Disease: A Systematic Review and Meta-Analysis.
Article in JAMA cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
20 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Importance: There is uncertainty about the effects of intensive blood pressure (BP) lowering on risks of cardiovascular disease and kidney failure in patients with chronic kidney disease (CKD). Objective: To assess the standardized effects of intensive BP lowering on cardiovascular and kidney outcomes overall, and then to assess for effect modification by CKD status. Data Sources: MEDLINE and Embase databases were searched from inception to January 16, 2026. Study Selection: Randomized clinical trials comparing intensive vs standard BP lowering in adults with and without CKD, with at least 1 year of follow-up, were eligible for inclusion. Data Extraction and Synthesis: Meta-analyses were performed using inverse variance weighting after standardizing trial results according to the between-group difference in achieved systolic BP (SBP). Differences in relative effects between CKD and non-CKD populations were assessed using χ2 tests for heterogeneity. Main Outcomes and Measures: The primary outcome was major cardiovascular events; secondary outcomes included kidney failure and estimated glomerular filtration rate (eGFR)-based surrogate outcomes for kidney failure. Results: We identified 27 studies including 88 830 participants. Intensive BP lowering reduced the risk of cardiovascular events by 15% per 10-mm Hg lower SBP (relative risk [RR], 0.85; 95% CI, 0.81-0.89), without heterogeneity by CKD status. This corresponded to an estimated (SE) absolute reduction of 4.3 (1.2) cardiovascular events per 1000 person-years in individuals with CKD and 2.7 (0.4) events per 1000 person-years in those without CKD. Intensive BP lowering did not affect risk of kidney failure (RR per 10-mm Hg reduction, 0.97; 95% CI, 0.84-1.11) nor risk of 57% or 50% sustained eGFR declines (RR, 0.97; 95% CI, 0.83-1.14; and RR, 1.29; 95% CI, 0.94-1.76, respectively), without heterogeneity by CKD subgroup. Intensive BP lowering increased risk of 30% or greater and 40% or greater declines by 42% (RR, 1.42; 95% CI, 1.28-1.58) and 47% (RR, 1.47; 95% CI, 1.30-1.66). Conclusions and Relevance: Results of this systematic review and meta-analysis indicate that in adults with or without CKD, intensive BP lowering reduced the risk of cardiovascular events by 15% per 10-mm Hg lower SBP and increased the risk of sustained declines in eGFR, without an increase in risk of kidney failure. However, since baseline cardiovascular risk is higher in CKD, the absolute reduction in cardiovascular events was at least as large in this population; therefore, intensive BP lowering should be recommended in people with and without CKD.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.