# Effect of Blood Pressure Control on Cardiovascular Events in Patients with Chronic Kidney Disease: A Systematic Review

## TL;DR

This review finds that controlling blood pressure can reduce cardiovascular risks in patients with chronic kidney disease, but careful treatment is needed to avoid kidney harm.

## Contribution

The study systematically evaluates the effectiveness of blood pressure interventions in reducing cardiovascular events among CKD patients.

## Key findings

- Intensive blood pressure control significantly reduces cardiovascular events in CKD patients.
- RAAS blockers and SGLT2 inhibitors show cardiovascular benefits but may increase risks like acute kidney injury.
- Nutraceuticals demonstrate potential anti-inflammatory and BP-lowering effects.

## Abstract

Cardiovascular disease remains the leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), with hypertension, common in this population, contributing significantly to vascular damage and cardiovascular risk. This systematic review evaluates the impact of blood pressure (BP) control on cardiovascular outcomes in individuals with CKD. A comprehensive search of PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science up to May 5, 2025, identified randomized controlled trials (RCTs) and prospective comparative studies assessing BP interventions and cardiovascular outcomes in CKD populations. Methodological quality was appraised using the Modified Downs and Black checklist. Of the 11,606 studies screened, 10 met the inclusion criteria. Interventions included intensive BP targets, renin-angiotensin-aldosterone system (RAAS) blockers, sodium-glucose cotransporter-2 (SGLT2) inhibitors, and antioxidant therapies. Most studies reported significant reductions in cardiovascular events, particularly with intensive BP control, though risks such as acute kidney injury (AKI) and hyperkalemia were noted. Nutraceuticals showed potential for anti-inflammatory and BP-lowering benefits. Overall, the methodological quality was high, with most studies rated as good to excellent. Targeted BP control appears to significantly reduce cardiovascular risk in CKD patients; however, individualized treatment strategies are essential to minimize adverse renal outcomes. While the evidence supports the cardiovascular benefits of BP management in this population, further research is needed to optimize intervention strategies and define safety thresholds.