title: Association of Intensive Blood Pressure Control and Kidney Disease Progression in Nondiabetic Patients With Chronic Kidney Disease: A Systematic Review and Meta-analysis.
abstract: The optimal blood pressure (BP) target remains debated in nondiabetic patients with chronic kidney disease (CKD).
  
  
  
  To compare intensive BP control (<130/80 mm Hg) with standard BP control (<140/90 mm Hg) on major renal outcomes in patients with CKD without diabetes.
  
  
  
  Searches of PubMed, MEDLINE, Embase, and Cochrane Library for publications up to March 24, 2016.
  
  
  
  Randomized clinical trials that compared an intensive vs a standard BP target in nondiabetic adults with CKD, reporting changes in glomerular filtration rate (GFR), doubling of serum creatinine level, 50% reduction in GFR, end-stage renal disease (ESRD), or all-cause mortality.
  
  
  
  Random-effects meta-analyses for pooling effect measures. Meta-regression and subgroup analyses for exploring heterogeneity.
  
  
  
  Differences in annual rate of change in GFR were expressed as mean differences with 95% CIs. Differences in doubling of serum creatinine or 50% reduction in GFR, ESRD, composite renal outcome, and all-cause mortality were expressed as risk ratios (RRs) with 95% CIs.
  
  
  
  We identified 9 trials with 8127 patients and a median follow-up of 3.3 years. Compared with standard BP control, intensive BP control did not show a significant difference on the annual rate of change in GFR (mean difference, 0.07; 95% CI, -0.16 to 0.29 mL/min/1.73 m2/y), doubling of serum creatinine level or 50% reduction in GFR (RR, 0.99; 95% CI, 0.76-1.29), ESRD (RR, 0.96; 95% CI, 0.78-1.18), composite renal outcome (RR, 0.99; 95% CI, 0.81-1.21), or all-cause mortality (RR, 0.95; 95% CI, 0.66-1.37). Nonblacks and patients with higher levels of proteinuria showed a trend of lower risk of kidney disease progression with intensive BP control.
  
  
  
  Targeting BP below the current standard did not provide additional benefit for renal outcomes compared with standard treatment during a follow-up of 3.3 years in patients with CKD without diabetes. However, nonblack patients or those with higher levels of proteinuria might benefit from the intensive BP-lowering treatments.
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan2Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan3Department of Marketing and Distribution Management, Oriental Institute of Technology, New Taipei City, Taiwan.
authors.forename: Wan-Chuan
authors.initials: WC
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan2Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan4Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan5School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Hon-Yen
authors.initials: HY
authors.lastname: Wu
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan4Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Yu-Sen
authors.initials: YS
authors.lastname: Peng
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan4Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Ju-Yeh
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan4Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Hung-Yuan
authors.initials: HY
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan4Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Yen-Ling
authors.initials: YL
authors.lastname: Chiu
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan4Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Shih-Ping
authors.initials: SP
authors.lastname: Hsu
authors.affiliation: Department of Dermatology, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan7Department of Dermatology, Taipei City Hospital, Taipei, Taiwan.
authors.forename: Mei-Ju
authors.initials: MJ
authors.lastname: Ko
authors.affiliation: Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan4Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Mei-Fen
authors.initials: MF
authors.lastname: Pai
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors.forename: Yu-Kang
authors.initials: YK
authors.lastname: Tu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Kuan-Yu
authors.initials: KY
authors.lastname: Hung
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan4Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
authors.forename: Kuo-Liong
authors.initials: KL
authors.lastname: Chien
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D018450:Disease Progression; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006977:Hypertension, Renal / Q000209:etiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis; D012307:Risk Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents