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Review
. 2025 Jun 17;17(6):e86230.
doi: 10.7759/cureus.86230. eCollection 2025 Jun.

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

Anas E Ahmed  1 , Khaled W Halawany  2 , Faizah S Alyahyawi  3 , Abdullah H Khormi  3 , Hussain M AlQibti  3 , Othman M Saifain  4 , Talal M Alqarni  5 , Jana S Alqurashi  6 , Rose M Alabdali  6 , Shoog T Alowaimer  6
Affiliations
Review

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

Anas E Ahmed et al. Cureus. .

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.

Keywords: acute kidney injury; antioxidant therapy; blood pressure control; cardiovascular disease; cardiovascular outcomes; chronic kidney disease; hypertension; nutraceuticals; renin-angiotensin-aldosterone system blockers; sodium-glucose cotransporter inhibitors.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flowchart for the search and selection of the studies
See this image and copyright information in PMC

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