Department of Research & Evaluation News

The benefits of intensive blood pressure shown in the Systolic Blood Pressure Intervention Trial (SPRINT) also helps patients with chronic kidney disease, according to new research led by Kaiser Permanente and Stanford University. The study was published in January 2025 in JAMA Network Open.

The SPRINT clinical trial included adults with hypertension and elevated cardiovascular risk. It showed that targeting a systolic blood pressure of less than 120 mm Hg resulted in fewer heart attacks and deaths than targeting a blood pressure of more than 140 mm Hg. The trial, which did not include patients with diabetes, also showed some risks with the lower blood pressure targets. They included low blood pressure, fainting, electrolyte abnormalities, and acute kidney injury or acute kidney failure, but not falls that caused injury.

Study used real-world data

“The real-world data from Kaiser Permanente Southern California and the Veterans Health Administration showed that the SPRINT results are applicable to patients with chronic kidney disease,” said research co-author, Jaejin An, PhD, a pharmacoepidemiologist with the Kaiser Permanente Southern California Department of Research & Evaluation. “This means that we would see benefits of implementing intensive blood pressure targets in our trial-eligible population with chronic kidney disease.”

To determine whether the effects of the SPRINT trial transferred to patients with chronic kidney disease, researchers assessed 2 groups of patients with chronic kidney disease between January 1 and December 31, 2019. A total of 13,983 patients from Kaiser Permanente Southern California and 85,938 patients from the Veterans Health Administration were included in the study. The mean age was 75.7 years among the patients at the Veterans Health Administration and 95.0% of patients were male. Among the Kaiser Permanente patients, the mean age was 77.4 years and 38.4% of patients were male.

Study results mixed

Results of the study showed that the associations of intensive versus standard blood pressure control with major cardiovascular events, all-cause death, and adverse events were similar between the trial and real-world chronic kidney disease patients. There were a few effects that were not the same, including dementia.

Intensive versus standard blood pressure treatment was associated with:

• Lower risk for major cardiovascular events at 4 years by
  • 1% among the Veterans Health Administration patients and
  • 0% in the Kaiser Permanente Southern California patients, and
• Higher risks for adverse events by
  • 3% in the Veterans Health Administration population, and
  • 1% in the Kaiser Permanente Southern California population.

“It’s important to note that we found only 1 in 5 of our Kaiser Permanente patients with chronic kidney disease met the eligibility criteria for the SPRINT trial, which required patients to not have end-stage kidney disease, diabetes, or protein in their urine, which is typically a sign of kidney issues,” said Dr. An.  “We’re currently working on a follow-up study to examine the benefits of intensive blood pressure targets for the overall population with chronic kidney disease, regardless of trial eligibility.”

More study needed

Study co-author John Sim, MD, of the Kaiser Permanente Los Angeles Medical Center and the Department of Research & Evaluation emphasized that their study helped validate findings that intensive blood pressure is indeed beneficial for CKD patients who are similar to SPRINT clinical trial patients.

“However, the majority of these patients were mild or early CKD,” Dr. Sim said. “It gets a little murky when we examined advanced CKD patients who we found to have higher risk for adverse cardiovascular outcomes and kidney injury with intensive blood pressure treatment. A knowledge gap remains among advanced CKD patients in terms of how to optimally manage hypertension, and thus more research is needed in this area. We look forward to learning more.”

This study was supported by a grant from the National Institutes of Health.

Other authors of the study included lead author Manjula Kurella Tamura, MD, MPH, of Stanford University; Mengjiao Huang, MS, PhD, and Michelle C. Odden, PhD, of the Geriatric Research, Education and Clinical Center, Veterans Health Administration;  Mengnan Zhou, BS, and Fang Niu, MS, of the Department of Research & Evaluation; Nicholas M. Pajewski, PhD, and Sarah A. Gaussoin, BS, of Wake Forest University; June Li, MS, Tara I. Chang, MD, MS, Vivek Charu, MD, PhD, and senior author Maria E. Montez-Rath, MS, PhD, of Stanford.