Blood pressure lowering treatment for prevention of cardiovascular diseases in people with and without chronic kidney disease: an individual participant-level data meta-analysis
Bibliographic record
Abstract
Abstract Background While the deleterious impact of hypertension on both cardiovascular and renal outcomes is well documented, a critical knowledge gap remains regarding whether pharmacological blood pressure-lowering treatment yields differential benefits in cardiovascular risk reduction across the spectrum of chronic kidney disease (CKD). Purpose This study aimed to assess the effect of a fixed amount of systolic blood pressure reduction on major cardiovascular outcomes in individuals with and without CKD. It also examined whether the treatment effect in individuals with CKD varies by CKD progression stages and systolic blood pressure categories at baseline. Methods A one-stage individual participant-level meta-analysis was conducted using the Blood Pressure Lowering Treatment Trialists’ Collaboration (BPLTTC) dataset. The intervention group was defined as follows: the active treatment arm in placebo-controlled trials, the group with the greater systolic blood pressure reduction in head-to-head trials, and the intensive treatment group in trials comparing different blood pressure-lowering strategies. The primary outcome was a composite of fatal and non-fatal stroke, myocardial infarction, ischaemic heart disease, and heart failure requiring hospitalisation or resulting in death. Cox proportional hazard models, stratified by trial, were used to estimate hazard ratios (HRs) separately by CKD status at baseline, with further stratification by CKD stages (1, 2, 3a, 3b, and 4–5) and baseline categories of systolic blood pressure (in 10 mm Hg increments from <120 mm Hg to ≥170 mm Hg). Results A total of 268,615 participants from 45 randomised trials were included, of whom 55,716 met the criteria of a CKD diagnosis based on eGFR below 60 mL/min/1.73m2. Over a median follow-up of four years, each 5 mm Hg reduction in systolic blood pressure lowered the risk of major cardiovascular events in both individuals with CKD (HR 0.91, 95% confidence interval [CI] 0.87–0.94) and those without CKD at baseline (HR 0.90, 95% CI 0.88–0.92; P interaction > 0.99). We found no reliable evidence for heterogeneity of treatment effects by detailed CKD stages and systolic blood pressure categories at baseline (Figure). Conclusion Pharmacological blood pressure lowering should be considered for people at high risk of cardiovascular diseases regardless of CKD status, CKD stages and systolic blood pressure categories at the time of treatment initiation.Figure
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.036 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.017 | 0.057 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".