Meta-analysis of 27 trials: tighter blood-pressure targets cut heart risk with or without chronic kidney disease

Whether aggressive blood-pressure lowering helps people with chronic kidney disease (CKD) has long been uncertain. A systematic review and meta-analysis in JAMA Cardiology, summarised by JAMA on 30 October 2026, pooled the evidence.

The study

• 27 randomised clinical trials, including 3 new major trials, comparing intensive vs standard blood-pressure targets.
• About 88,800 participants with and without CKD.

Findings

• Intensive treatment was linked to about 4 fewer major cardiovascular events per 1,000 person-years in people with CKD and about 3 fewer in people without CKD.
• It did not change the risk of kidney failure.
• It was linked to more sustained declines in kidney function when less severe eGFR (filtration rate) thresholds were used.

The authors say guidelines should recommend intensive lowering for people with or without CKD, with careful monitoring of kidney function.

Limitations

A meta-analysis is only as good as the trials it combines, which used different targets, drugs and populations; the absolute benefit is modest; and the finding on kidney-function decline means the trade-off has to be weighed person by person. This article is based on JAMA’s summary of the paper. Do not change your blood-pressure treatment without talking to your doctor.