Intensive Blood Pressure Control Beneficial Across CKM Syndrome Stages: JAMA
China: A post hoc analysis of a cluster-randomized trial has found that targeting blood pressure below 130/80 mm Hg yielded a favorable benefit-to-harm profile across all stages of cardiovascular-kidney-metabolic (CKM) syndrome. The benefits were consistent across stages, with no significant variation, offering the first trial-based evidence to guide CKM management and supporting scalable intensive BP control strategies in this high-risk population.
The study, published in JAMA Network Open by Xiaofan Guo of the Department of Cardiology at the First Hospital of China Medical University and colleagues, explored whether intensive blood pressure (BP) management yields consistent clinical benefits across different stages of CKM syndrome. This syndrome encompasses a spectrum of overlapping cardiovascular, kidney, and metabolic disorders, with hypertension playing a central role in driving organ dysfunction and disease progression. Despite this, evidence on stage-specific benefits of strict BP control has been limited until now.
Researchers conducted a secondary analysis of the China Rural Hypertension Control Project (CRHCP), a large cluster randomized trial including over 33,700 adults aged 40 years and above with hypertension and CKM syndrome stages 2 to 4. Stage 2 was defined by the presence of a metabolic risk factor, stage 3 included subclinical cardiovascular disease or a predicted 10-year risk of 20% or more, and stage 4 involved established clinical cardiovascular disease.
Participants were followed for a median of just over three years, and the intensive BP intervention was delivered by trained nonphysician practitioners aiming for a systolic BP under 130 mm Hg and a diastolic BP under 80 mm Hg.
Key findings were as follows:
- Intensive blood pressure (BP) control significantly reduced the risk of major cardiovascular events—including stroke, myocardial infarction, heart failure, and cardiovascular death—across all CKM stages.
- Hazard ratios (HR) for cardiovascular events were 0.61 for stage 2, 0.71 for stage 3, and 0.67 for stage 4, indicating consistent risk reduction across stages.
- All-cause mortality was lower in stage 2 (HR 0.73) and stage 3 (HR 0.82), but no significant mortality benefit was seen in stage 4.
- The intervention increased the risk of hypotension across all stages.
- Other adverse events, including kidney-related complications, were largely similar between intervention and control groups.
- Quantitative benefit-harm analysis showed a favorable profile for intensive BP management.
- Net benefit scores were high across all CKM stages, indicating that the clinical advantages of intensive BP lowering outweighed potential harms.
These findings highlight the feasibility of implementing intensive BP control strategies, even in resource-limited settings such as rural China, where multimorbid populations are at particularly high risk for cardiovascular complications.
Overall, this study provides the first trial-based, stage-specific evidence supporting aggressive blood pressure management in adults with CKM syndrome. By demonstrating consistent cardiovascular protection without excessive harm, it offers a strong foundation for healthcare providers to adopt scalable intensive BP interventions in diverse high-risk populations.
Reference:
Guo X, Zhou S, Mu J, et al. Intensive Blood Pressure Control and Cardiovascular Outcomes Across Cardiovascular-Kidney-Metabolic Syndrome Stages: A Post Hoc Analysis of the China Rural Hypertension Control Project. JAMA Netw Open. 2026;9(2):e2557180. doi:10.1001/jamanetworkopen.2025.57180
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