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High blood pressure forces the heart to work harder to pump blood. Over time, this extra strain can thicken the heart muscle and narrow the arteries, further complicating cardiovascular health. Even in people with no other health conditions, a 20 mmHg rise in blood pressure doubles the risk of dying from heart disease.
Lowering high blood pressure protects the heart and blood vessels, but how low should it go? Doctors have long debated whether more aggressive targets, such as a systolic blood pressure below 120 or 130 mmHg, offer additional protection or cause harm, particularly in people with chronic kidney disease (CKD).
A recent meta-analysis screened multiple prior clinical trials to assess the effects of intensive blood pressure lowering (below 120 or 130 mmHg) versus standard blood pressure targets (below 140 mmHg).
Across the trials, intensive treatment reduced major cardiovascular events by 15% for each 10 mmHg reduction in systolic pressure in adults with or without chronic kidney disease. While the treatment did not increase the risk of kidney failure compared with standard treatment, it did make temporary or mild declines in eGFR more likely. This measure, based on a blood test, indicates how well the kidneys filter waste from the blood.
Chronic kidney disease is a sneaky condition as it rarely announces itself with noticeable symptoms until it's too late. Kidney function declines gradually, allowing waste and excess fluid to accumulate in the body.
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