ESC Congress 2026 Abstract · Oct 26, 2026

Effects of intensive blood pressure control in patients with cardiovascular-kidney-metabolic syndrome:a post hoc analysis from ESPRIT

By Li Y

Background: Evidence regarding the benefits and harms of intensive blood pressure control in patients with different stages of Cardiovascular-Kidney-Metabolic (CKM) syndrome remains limited. Methods: From the ESPRIT trial (Effects of intensive Systolic blood Pressure lowering treatment in reducing RIsk of vascular evenTs), participants with complete data were categorized by CKM staging followed AHA guidelines. The primary outcome was a composite of myocardial infarction, revascularisation, hospitalization for heart failure, stroke or death from cardiovascular causes. We used Cox proportional hazards models to evaluate the effects of intensive treatment on primary outcome, MACE (a composite of myocardial infarction, hospitalization for heart failure, stroke, or death from cardiovascular diseases) all-cause death, and safety outcomes (kidney outcomes, and other serious adverse events of special interest [hypotension, syncope, electrolyte abnormality, injurious fall, or acute kidney injury]. Results: We included 11,255 participants whose average age was 64.6 ± 7.1 years. Of the total participants, 2,542 (22.6%) were stage 2 CKM, 2,836 (25.2%) were stage 3 CKM, and 5,877 (52.2%) were stage 4 CKM. The effect of intensive treatment on primary and secondary outcomes did not differ significantly on the relative scale (Pinteraction > 0.05). Furthermore, no significant interaction (except for kidney outcome; Pinteraction = 0.008]) was observed between CKM stages and the risk of serious adverse events associated with intensive treatment (Pinteraction > 0.05). Conclusion: Hypertensive patients with high cardiovascular risk benefit from the treatment strategy of targeting systolic BP <120 mm Hg, regardless of their CKM stage status. In addition, the effects of intensive treatment on experiencing adverse events did not differ by CKM status except for kidney outcome.Forest plot

doi.org/10.1093/eurheartj/ehag785.3687 Open access Interventions