Table 1:

Characteristics of the studies included in the meta-analysis

StudyInclusion criteriaBP, mm HgRegimen used to achieve target BPFollow-up, yrPatient characteristic
Baseline, systolic/diastolicTarget in intervention groupTarget in control groupTotal, no.With CKD, no.Age, mean, yrFemale sex, %Diabetes mellitus, %Kidney failure, no.Major CV event, no.
Studies that only recruited patients with CKD
AASK (Appel et al.13; Wright et al.26)African American, hypertension, GFR 20–65 mL/min per 1.73 m2 and no other identified causes of renal insufficiency150.5/95.5Mean < 92Mean 102–1073 × 2 study design; participants were separately and randomly assigned to a class of drugs (ramipril, metoprolol or amlodipine) and separately to the BP target; in the cohort phase, all were switched from randomized therapy to ramipril8.8–12.21 0941 0945538.8Excluded422225
Ruggenenti et al.14Nondiabetic nephropathy with proteinuria 1–3 g/d and GFR < 45 mL/min per 1.73 m2 or proteinuria > 3 g/d and GFR < 70 mL/min per 1.73 m2136.7/84.1< 130/80Diastolic < 90All patients were given ramipril and received add-on therapy with felodipine as required1.63383385425.7Excluded729
Klahr et al.17CKD, serum creatinine 1.4–7.0 mg/dL (male) or 1.2–7.0 mg/dL (female)130.5/80Mean < 92Mean < 107ACE inhibitors, with or without a diuretic16.784084052405.10616NR*
Wühl et al.18CKD, age 3–18 yr and GFR 15–80 mL/min per 1.73 m2 with 24-h mean BP elevated or controlled by antihypertensive agents118.3/73.024-hr mean BP < 50th percentile24-hr mean BP in the 50th– 95th percentileAll patients were given ramipril and received any other class of antihypertensive agents as required5.03853851241NR115§NR
Toto et al.21Hypertensive nephrosclerosis, serum creatinine > 1.6 mg/dL or GFR < 70 mL/min per 1.73 m2123.1/76.5Diastolic, 65– 80Diastolic, 85– 952 × 2 study design; patients were randomized to either placebo or enalapril and then a stepped-care approach: diuretic; n-blocker; hydralazineor minoxidil; and clonidine, α-methyldopa or R1- blocker3.477775637.7Excluded19NR
Schrier et al.28Autosomal-dominant polycystic kidney disease with hypertension and left ventricular hypertrophy; age 20–60 yr; creatinine clearance > 30 mL/min;142.5/94.5< 120/80< 135–140/85–90Patients were randomized to either enalapril- or amlodipine-based approaches7.075754145NR8NR
Studies reporting subgroup data for patients with CKD
UK Prospective Diabetes Study Group22*Newly diagnosed type 2 diabetes mellitus with hypertension159.3/94< 150/85< 180/105Captopril or atenolol8.41 1481035644.5100NR*NR*
Hansson et al.23*Hypertension, diastolic BP 100–115 mm Hg169.7/105.4Diastolic < 80Diastolic < 85 or < 90All initially received felodipine and add-on therapy with ACE inhibitors or β-blockers and then a diuretic3.81 87903 61962478NR*186
Estacio et al.24*Type 2 diabetes mellitus with diastolic BP ≥ 90 mm Hg155/98Diastolic < 75Diastolic 80–89Patients were randomized to either enalapril or amlodipine initially, and received add-on with metoprolol and hydrochlorothiazide5.04701205832.6100NR*29
Schrier et al.25*Type 2 diabetes mellitus with normotension (diastolic BP 80– 89 mm Hg)136.4/84.4Reduction in diastolic BP of 10 mm Hg from baselineDiastolic 80–89In the intensive group, patients were randomized to either tonisoldipine or enalapril5.34801375945.5100NR*23
Hayashi et al.27*Older adults (65–85 yr), hypertension and systolic BP > 160 mm Hg163/89.6Systolic < 140Systolic < 160All patients received efonidipine and other agents were added as needed2.04 4182 499746411.913NR
  • Note: ACE = angiotensin-converting enzyme, BP = blood pressure, CKD = chronic kidney disease, CV = cardiovascular, GFR = glomerular filtration rate, NR = not reported.

  • * CKD was determined by estimated GFR < 60 mL/min per 1.73 m2.

  • Kidney failure defined as either a composite of 50% decline in GFR, 100% increase in serum creatinine or end-stage kidney disease.

  • Kidney failure defined as end-stage kidney disease.

  • § Kidney failure defined as a composite of 50% decline in GFR or end-stage kidney disease.

  • Kidney failure defined as a composite of 100% increase in serum creatinine or end-stage kidney disease.