Eleven RCTs (9,287 patients with chronic kidney disease, range 75 to 3,619) met the inclusion criteria. Four RCTs did not describe allocation concealment, two trials blinded patients, six trials blinded outcome assessors, five trials used intention-to-treat analysis and seven trials had less than 10% of incomplete outcome data; none reported blinding investigators. Follow-up ranged from 1.6 to 16.7 years.
Compared with standard antihypertensive regimens (seven RCTs, 5,308 patients), intensive strategies significantly reduced the risk of doubling of serum creatinine level/50% decline in glomerular filtration rate/end-stage kidney disease (HR 0.82, 95% CI 0.68 to 0.98; Ι²=38.1%) and end-stage kidney disease (HR 0.79, 95% CI 0.67 to 0.93; Ι²=21.6%); there was no evidence for publication bias. Baseline proteinuria, allocation concealment and blinding of outcome assessors were shown to have significant impact on the results. There was no significant difference between regimens on the risk of cardiovascular events (five RCTs, 5,308 patients), stroke (six RCTs, 5,411 patients), myocardial infarction (five RCTs, 4,317 patients), heart failure (five RCTs, 5,308 patients) and death (10 RCTs, 6,788 patients).
Adverse events: There was no significant difference between regimens on severe adverse events (two RCTs, 723 patients), hypotension (three RCTs) and treatment discontinuation (three RCTs); none of the trials reported on the risk of acute kidney injury.