Research
Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis
Jicheng Lv, Parya Ehteshami, Mark J. Sarnak, Hocine Tighiouart, Min Jun, Toshiharu Ninomiya, Celine Foote, Anthony Rodgers, Hong Zhang, Haiyan Wang, Giovanni F.M. Strippoli and Vlado Perkovic
CMAJ August 06, 2013 185 (11) 949-957; DOI: https://doi.org/10.1503/cmaj.121468
Jicheng Lv
The George Institute for Global Health (Lv, Ehteshami, Jun, Foote, Rodgers, Perkovic), The University of Sydney, Sydney, Australia; Renal Division, Department of medicine (Lv, Zhang, Wang), Peking University First Hospital, Beijing, China; Tufts Medical Center (Sarnak, Tighiouart), Boston, Mass.; the Department of Medicine and Clinical Science Graduate School of Medical Sciences (Ninomiya), Kyushu University, Japan; the Centre for Kidney Research (Strippoli), The Children’s Hospital at Westmead, School of Public Health, The University of Sydney, Sydney, Australia; the Department of Pharmacology and Epidemiology (Strippoli), Mario Negri Sud Consortium, S Maria Imbaro, Chieti, Italy; and DIAVERUM Medical-Scientific Office (Strippoli), Lund, Sweden
Parya Ehteshami
The George Institute for Global Health (Lv, Ehteshami, Jun, Foote, Rodgers, Perkovic), The University of Sydney, Sydney, Australia; Renal Division, Department of medicine (Lv, Zhang, Wang), Peking University First Hospital, Beijing, China; Tufts Medical Center (Sarnak, Tighiouart), Boston, Mass.; the Department of Medicine and Clinical Science Graduate School of Medical Sciences (Ninomiya), Kyushu University, Japan; the Centre for Kidney Research (Strippoli), The Children’s Hospital at Westmead, School of Public Health, The University of Sydney, Sydney, Australia; the Department of Pharmacology and Epidemiology (Strippoli), Mario Negri Sud Consortium, S Maria Imbaro, Chieti, Italy; and DIAVERUM Medical-Scientific Office (Strippoli), Lund, Sweden
Mark J. Sarnak
The George Institute for Global Health (Lv, Ehteshami, Jun, Foote, Rodgers, Perkovic), The University of Sydney, Sydney, Australia; Renal Division, Department of medicine (Lv, Zhang, Wang), Peking University First Hospital, Beijing, China; Tufts Medical Center (Sarnak, Tighiouart), Boston, Mass.; the Department of Medicine and Clinical Science Graduate School of Medical Sciences (Ninomiya), Kyushu University, Japan; the Centre for Kidney Research (Strippoli), The Children’s Hospital at Westmead, School of Public Health, The University of Sydney, Sydney, Australia; the Department of Pharmacology and Epidemiology (Strippoli), Mario Negri Sud Consortium, S Maria Imbaro, Chieti, Italy; and DIAVERUM Medical-Scientific Office (Strippoli), Lund, Sweden
Hocine Tighiouart
The George Institute for Global Health (Lv, Ehteshami, Jun, Foote, Rodgers, Perkovic), The University of Sydney, Sydney, Australia; Renal Division, Department of medicine (Lv, Zhang, Wang), Peking University First Hospital, Beijing, China; Tufts Medical Center (Sarnak, Tighiouart), Boston, Mass.; the Department of Medicine and Clinical Science Graduate School of Medical Sciences (Ninomiya), Kyushu University, Japan; the Centre for Kidney Research (Strippoli), The Children’s Hospital at Westmead, School of Public Health, The University of Sydney, Sydney, Australia; the Department of Pharmacology and Epidemiology (Strippoli), Mario Negri Sud Consortium, S Maria Imbaro, Chieti, Italy; and DIAVERUM Medical-Scientific Office (Strippoli), Lund, Sweden
Min Jun
The George Institute for Global Health (Lv, Ehteshami, Jun, Foote, Rodgers, Perkovic), The University of Sydney, Sydney, Australia; Renal Division, Department of medicine (Lv, Zhang, Wang), Peking University First Hospital, Beijing, China; Tufts Medical Center (Sarnak, Tighiouart), Boston, Mass.; the Department of Medicine and Clinical Science Graduate School of Medical Sciences (Ninomiya), Kyushu University, Japan; the Centre for Kidney Research (Strippoli), The Children’s Hospital at Westmead, School of Public Health, The University of Sydney, Sydney, Australia; the Department of Pharmacology and Epidemiology (Strippoli), Mario Negri Sud Consortium, S Maria Imbaro, Chieti, Italy; and DIAVERUM Medical-Scientific Office (Strippoli), Lund, Sweden
Toshiharu Ninomiya
The George Institute for Global Health (Lv, Ehteshami, Jun, Foote, Rodgers, Perkovic), The University of Sydney, Sydney, Australia; Renal Division, Department of medicine (Lv, Zhang, Wang), Peking University First Hospital, Beijing, China; Tufts Medical Center (Sarnak, Tighiouart), Boston, Mass.; the Department of Medicine and Clinical Science Graduate School of Medical Sciences (Ninomiya), Kyushu University, Japan; the Centre for Kidney Research (Strippoli), The Children’s Hospital at Westmead, School of Public Health, The University of Sydney, Sydney, Australia; the Department of Pharmacology and Epidemiology (Strippoli), Mario Negri Sud Consortium, S Maria Imbaro, Chieti, Italy; and DIAVERUM Medical-Scientific Office (Strippoli), Lund, Sweden
Celine Foote
The George Institute for Global Health (Lv, Ehteshami, Jun, Foote, Rodgers, Perkovic), The University of Sydney, Sydney, Australia; Renal Division, Department of medicine (Lv, Zhang, Wang), Peking University First Hospital, Beijing, China; Tufts Medical Center (Sarnak, Tighiouart), Boston, Mass.; the Department of Medicine and Clinical Science Graduate School of Medical Sciences (Ninomiya), Kyushu University, Japan; the Centre for Kidney Research (Strippoli), The Children’s Hospital at Westmead, School of Public Health, The University of Sydney, Sydney, Australia; the Department of Pharmacology and Epidemiology (Strippoli), Mario Negri Sud Consortium, S Maria Imbaro, Chieti, Italy; and DIAVERUM Medical-Scientific Office (Strippoli), Lund, Sweden
Anthony Rodgers
The George Institute for Global Health (Lv, Ehteshami, Jun, Foote, Rodgers, Perkovic), The University of Sydney, Sydney, Australia; Renal Division, Department of medicine (Lv, Zhang, Wang), Peking University First Hospital, Beijing, China; Tufts Medical Center (Sarnak, Tighiouart), Boston, Mass.; the Department of Medicine and Clinical Science Graduate School of Medical Sciences (Ninomiya), Kyushu University, Japan; the Centre for Kidney Research (Strippoli), The Children’s Hospital at Westmead, School of Public Health, The University of Sydney, Sydney, Australia; the Department of Pharmacology and Epidemiology (Strippoli), Mario Negri Sud Consortium, S Maria Imbaro, Chieti, Italy; and DIAVERUM Medical-Scientific Office (Strippoli), Lund, Sweden
Hong Zhang
The George Institute for Global Health (Lv, Ehteshami, Jun, Foote, Rodgers, Perkovic), The University of Sydney, Sydney, Australia; Renal Division, Department of medicine (Lv, Zhang, Wang), Peking University First Hospital, Beijing, China; Tufts Medical Center (Sarnak, Tighiouart), Boston, Mass.; the Department of Medicine and Clinical Science Graduate School of Medical Sciences (Ninomiya), Kyushu University, Japan; the Centre for Kidney Research (Strippoli), The Children’s Hospital at Westmead, School of Public Health, The University of Sydney, Sydney, Australia; the Department of Pharmacology and Epidemiology (Strippoli), Mario Negri Sud Consortium, S Maria Imbaro, Chieti, Italy; and DIAVERUM Medical-Scientific Office (Strippoli), Lund, Sweden
Haiyan Wang
The George Institute for Global Health (Lv, Ehteshami, Jun, Foote, Rodgers, Perkovic), The University of Sydney, Sydney, Australia; Renal Division, Department of medicine (Lv, Zhang, Wang), Peking University First Hospital, Beijing, China; Tufts Medical Center (Sarnak, Tighiouart), Boston, Mass.; the Department of Medicine and Clinical Science Graduate School of Medical Sciences (Ninomiya), Kyushu University, Japan; the Centre for Kidney Research (Strippoli), The Children’s Hospital at Westmead, School of Public Health, The University of Sydney, Sydney, Australia; the Department of Pharmacology and Epidemiology (Strippoli), Mario Negri Sud Consortium, S Maria Imbaro, Chieti, Italy; and DIAVERUM Medical-Scientific Office (Strippoli), Lund, Sweden
Giovanni F.M. Strippoli
The George Institute for Global Health (Lv, Ehteshami, Jun, Foote, Rodgers, Perkovic), The University of Sydney, Sydney, Australia; Renal Division, Department of medicine (Lv, Zhang, Wang), Peking University First Hospital, Beijing, China; Tufts Medical Center (Sarnak, Tighiouart), Boston, Mass.; the Department of Medicine and Clinical Science Graduate School of Medical Sciences (Ninomiya), Kyushu University, Japan; the Centre for Kidney Research (Strippoli), The Children’s Hospital at Westmead, School of Public Health, The University of Sydney, Sydney, Australia; the Department of Pharmacology and Epidemiology (Strippoli), Mario Negri Sud Consortium, S Maria Imbaro, Chieti, Italy; and DIAVERUM Medical-Scientific Office (Strippoli), Lund, Sweden
Vlado Perkovic
The George Institute for Global Health (Lv, Ehteshami, Jun, Foote, Rodgers, Perkovic), The University of Sydney, Sydney, Australia; Renal Division, Department of medicine (Lv, Zhang, Wang), Peking University First Hospital, Beijing, China; Tufts Medical Center (Sarnak, Tighiouart), Boston, Mass.; the Department of Medicine and Clinical Science Graduate School of Medical Sciences (Ninomiya), Kyushu University, Japan; the Centre for Kidney Research (Strippoli), The Children’s Hospital at Westmead, School of Public Health, The University of Sydney, Sydney, Australia; the Department of Pharmacology and Epidemiology (Strippoli), Mario Negri Sud Consortium, S Maria Imbaro, Chieti, Italy; and DIAVERUM Medical-Scientific Office (Strippoli), Lund, Sweden

Data supplements
Files in this Data Supplement:
- Appendix 1 : Searching strategy
- Appendix 2 : Risk of bias
- Appendix 3 : Begg's funnel plot for the assessment of publication bias in studies examining the effect of intensive blood pressure lowering on kidney failure
- Appendix 4 : Subgroup analysis of intensive blood pressure lowering on kidney failure
- Appendix 5 : Intensive blood pressure lowering and cardiovascular outcomes in patients with chronic kidney disease
Related Articles
- Hildebrand, A. M., & Garg, A. X. (2013). Blood pressure targets in chronic kidney disease: Does proteinuria dictate how low we go?. CMAJ, 185(11), 941-942. Accessed January 27, 2021. https://doi.org/10.1503/cmaj.130168.
In this issue
Article tools
Respond to this article
Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis
Jicheng Lv, Parya Ehteshami, Mark J. Sarnak, Hocine Tighiouart, Min Jun, Toshiharu Ninomiya, Celine Foote, Anthony Rodgers, Hong Zhang, Haiyan Wang, Giovanni F.M. Strippoli, Vlado Perkovic
CMAJ Aug 2013, 185 (11) 949-957; DOI: 10.1503/cmaj.121468
Effects of intensive blood pressure lowering on the progression of chronic kidney disease: a systematic review and meta-analysis
Jicheng Lv, Parya Ehteshami, Mark J. Sarnak, Hocine Tighiouart, Min Jun, Toshiharu Ninomiya, Celine Foote, Anthony Rodgers, Hong Zhang, Haiyan Wang, Giovanni F.M. Strippoli, Vlado Perkovic
CMAJ Aug 2013, 185 (11) 949-957; DOI: 10.1503/cmaj.121468
Jump to section
Related Articles
Cited By...
- Intensive Blood Pressure Lowering Should Be the Goal for Most Individuals at High Risk of Cardiovascular Disease Irrespective of Albuminuria
- Effects of Intensive Blood Pressure Control in Patients with and without Albuminuria: Post Hoc Analyses from SPRINT
- Progress in using the electronic health record to improve primary care
- Chronic kidney disease in adults: assessment and management
- Effects of antihypertensives, lipid-modifying drugs, glycaemic control drugs and sodium bicarbonate on the progression of stages 3 and 4 chronic kidney disease in adults: a systematic review and meta-analysis
- 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
- 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
- Improving coding and primary care management for patients with chronic kidney disease: an observational controlled study in East London
- Intensive Blood Pressure Targets and Kidney Disease
- Hypertension Management in Diabetes: 2018 Update
- The National CKD Audit: a primary care condition that deserves more attention
- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
- 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines
- Effects of Intensive BP Control in CKD
- 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America
- 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America
- Time-Varying Association of Individual BP Components with eGFR in Late-Stage CKD
- Etude SPRINT : Donnees probantes sur les cibles precises de la tension arterielle
- SPRINT to evidence for specific blood pressure targets
- Results and lessons from the Spironolactone To Prevent Cardiovascular Events in Early Stage Chronic Kidney Disease (STOP-CKD) randomised controlled trial
- Treating hypertension in patients with medical comorbidities
- Assessing the Validity of Surrogate Outcomes for ESRD: A Meta-Analysis
- Modification of the Relationship Between Blood Pressure and Renal Albumin Permeability by Impaired Excretory Function and Diabetes
- Blood Pressure and Risk of All-Cause Mortality in Advanced Chronic Kidney Disease and Hemodialysis: The Chronic Renal Insufficiency Cohort Study
- Blood pressure targets in chronic kidney disease: Does proteinuria dictate how low we go?