JAMA Netw Open

Does intensive blood press control risk kidney injury?

July 23, 2025

Lowering BP to <130/80 mm Hg was linked to a lower incidence of adverse cardiovascular outcomes compared with usual care—yet didn’t raise the risk of kidney injury in those without chronic kidney disease, according to this secondary analysis of a study in rural China.

Study details. A secondary analysis of the China Rural Hypertension Control Project involved 7,562 patients with baseline estimated GFR 60-90 mL/min/1.73 m² who had been randomized to intensive BP control (<130/80 mm Hg) vs. usual care delivered by nonphysician community clinicians. Primary outcomes included eGFR reduction of 30% to a rate <60 mL/min/1.73 m². The composite cardiovascular outcome included CV death, MI, HF, stroke. Follow-up: 36 months.

Results. Kidney outcome: 121 patients in the intensive control group vs. 101 in the usual-care group met criteria, which wasn’t statistically significant. Cardiovascular outcome: 2.0% of patients per year in the intensive control group vs. 3.3% per year in the usual care group met criteria for the composite cardiovascular outcome; the between-group difference was statistically significant (hazard ratio, 0.57; 95% confidence interval [CI], 0.47-0.68; P < .001).

Source:

Sun G, et al. (2025, July 8). JAMA Netw Open. Intensive Systolic Blood Pressure Reduction and Kidney and Cardiovascular Outcomes: A Secondary Analysis of a Randomized Clinical Trial. https://pubmed.ncbi.nlm.nih.gov/40643915/