Characteristics of the studies included in the meta-analysis
Study | Inclusion criteria | BP, mm Hg | Regimen used to achieve target BP | Follow-up, yr | Patient characteristic | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Baseline, systolic/diastolic | Target in intervention group | Target in control group | Total, no. | With CKD, no. | Age, mean, yr | Female 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 insufficiency | 150.5/95.5 | Mean < 92 | Mean 102–107 | 3 × 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 ramipril | 8.8–12.2 | 1 094 | 1 094 | 55 | 38.8 | Excluded | 422¶ | 225 |
Ruggenenti et al. (14) | Nondiabetic 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 m2 | 136.7/84.1 | < 130/80 | Diastolic < 90 | All patients were given ramipril and received add-on therapy with felodipine as required | 1.6 | 338 | 338 | 54 | 25.7 | Excluded | 72‡ | 9 |
Klahr et al. (17) | CKD, serum creatinine 1.4–7.0 mg/dL (male) or 1.2–7.0 mg/dL (female) | 130.5/80 | Mean < 92 | Mean < 107 | ACE inhibitors, with or without a diuretic | 16.7 | 840 | 840 | 52 | 40 | 5.10 | 616‡ | NR* |
Wühl et al. (18) | CKD, age 3–18 yr and GFR 15–80 mL/min per 1.73 m2 with 24-h mean BP elevated or controlled by antihypertensive agents | 118.3/73.0 | 24-hr mean BP < 50th percentile | 24-hr mean BP in the 50th– 95th percentile | All patients were given ramipril and received any other class of antihypertensive agents as required | 5.0 | 385 | 385 | 12 | 41 | NR† | 115§ | NR |
Toto et al. (21) | Hypertensive nephrosclerosis, serum creatinine > 1.6 mg/dL or GFR < 70 mL/min per 1.73 m2 | 123.1/76.5 | Diastolic, 65– 80 | Diastolic, 85– 95 | 2 × 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- blocker | 3.4 | 77 | 77 | 56 | 37.7 | Excluded | 19† | NR |
Schrier et al. (28) | Autosomal-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 | < 135–140/85–90 | Patients were randomized to either enalapril- or amlodipine-based approaches | 7.0 | 75 | 75 | 41 | 45 | NR | 8‡ | NR |
Studies reporting subgroup data for patients with CKD | |||||||||||||
UK Prospective Diabetes Study Group (22)* | Newly diagnosed type 2 diabetes mellitus with hypertension | 159.3/94 | < 150/85 | < 180/105 | Captopril or atenolol | 8.4 | 1 148 | 103 | 56 | 44.5 | 100 | NR* | NR* |
Hansson et al. (23)* | Hypertension, diastolic BP 100–115 mm Hg | 169.7/105.4 | Diastolic < 80 | Diastolic < 85 or < 90 | All initially received felodipine and add-on therapy with ACE inhibitors or β-blockers and then a diuretic | 3.8 | 1 8790 | 3 619 | 62 | 47 | 8 | NR* | 186 |
Estacio et al. (24)* | Type 2 diabetes mellitus with diastolic BP ≥ 90 mm Hg | 155/98 | Diastolic < 75 | Diastolic 80–89 | Patients were randomized to either enalapril or amlodipine initially, and received add-on with metoprolol and hydrochlorothiazide | 5.0 | 470 | 120 | 58 | 32.6 | 100 | NR* | 29 |
Schrier et al. (25)* | Type 2 diabetes mellitus with normotension (diastolic BP 80– 89 mm Hg) | 136.4/84.4 | Reduction in diastolic BP of 10 mm Hg from baseline | Diastolic 80–89 | In the intensive group, patients were randomized to either tonisoldipine or enalapril | 5.3 | 480 | 137 | 59 | 45.5 | 100 | NR* | 23 |
Hayashi et al. (27)* | Older adults (65–85 yr), hypertension and systolic BP > 160 mm Hg | 163/89.6 | Systolic < 140 | Systolic < 160 | All patients received efonidipine and other agents were added as needed | 2.0 | 4 418 | 2 499 | 74 | 64 | 11.9 | 13¶ | NR |
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.