A new benefit-harm trade-off analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) provides powerful evidence supporting an intensive systolic blood pressure (SBP) target of $\mathbf{<120\text{ mm Hg}}$ over $<140\text{ mm Hg}$ for adults with Chronic Kidney Disease (CKD).
Thank you for reading this post, don't forget to subscribe!The Net Benefit Favors Intensive Therapy
Investigators predicted individualized treatment effects across multiple outcomes (death, cardiovascular events, cognitive impairment vs. harms like AKI hospitalization and fainting) in 2,012 CKD participants:
- Universal Benefit: When simulating preferences that highly prioritize clinical benefits over harms, 100% of participants showed a positive net benefit favoring the intensive SBP goal.
- Widespread Support: Even with harms and benefits given similar importance, 9 out of 10 participants still had a positive net benefit.
Greater Net Benefit in Advanced CKD
While people with more advanced CKD (eGFR $20–44\text{ ml/min/1.73m}^2$) experienced more treatment-related harms than those with earlier-stage CKD (eGFR $45–59\text{ ml/min/1.73m}^2$), the magnitude of benefits was also larger.
This finding is critical: the advanced CKD group ultimately had a greater overall net benefit from the lower SBP target.
Conclusion
These results strongly support the existing KDIGO guidelines recommending an SBP target of $<120\text{ mm Hg}$ in hypertensive CKD adults. The data provides a robust, individualized justification to help overcome therapeutic inertia in intensifying BP control.
(Findings to be presented at ASN Kidney Week 2025, November 5–9.)
