Effects of Intensive Systolic Blood Pressure Control on Kidney and Cardiovascular Outcomes in Persons Without Kidney Disease
Year: 2017
Type: article
Abstract: BACKGROUND: The public health significance of the reported higher incidence of chronic kidney disease (CKD) with intensive systolic blood pressure (SBP) lowering is unclear. OBJECTIVE: To examine the effects of intensive SBP lowering on kidney and cardiovascular outcomes and contrast its apparent beneficial and adverse effects. DESIGN: Subgroup analyses of SPRINT (Systolic Blood Pressure Intervention Trial). (ClinicalTrials.gov: NCT01206062). SETTING: Adults with high blood pressure and elevated cardiovascular risk. PARTICIPANTS: 6662 participants with a baseline estimated glomerular filtration rate (eGFR) of at least 60 mL/min/1.73 m2. INTERVENTION: Random assignment to an intensive or standard SBP goal (120 or 140 mm Hg, respectively). MEASUREMENTS: Differences in mean eGFR during follow-up (estimated with a linear mixed-effects model), prespecified incident CKD (defined as a >30% decrease in eGFR to a value <60 mL/min/1.73 m2), and a composite of all-cause death or cardiovascular event, with surveillance every 3 months. RESULTS: The difference in adjusted mean eGFR between the intensive and standard groups was -3.32 mL/min/1.73 m2 (95% CI, -3.90 to -2.74 mL/min/1.73 m2) at 6 months, was -4.50 mL/min/1.73 m2 (CI, -5.16 to -3.85 mL/min/1.73 m2) at 18 months, and remained relatively stable thereafter. An incident CKD event occurred in 3.7% of participants in the intensive group and 1.0% in the standard group at 3-year follow-up, with a hazard ratio of 3.54 (CI, 2.50 to 5.02). The corresponding percentages for the composite of death or cardiovascular event were 4.9% and 7.1% at 3-year follow-up, with a hazard ratio of 0.71 (CI, 0.59 to 0.86). LIMITATION: Long-term data were lacking. CONCLUSION: Intensive SBP lowering increased risk for incident CKD events, but this was outweighed by cardiovascular and all-cause mortality benefits. PRIMARY FUNDING SOURCE: National Institutes of Health.
Source: Annals of Internal Medicine
DOI: 10.7326/m16-2966
Authors: Srinivasan Beddhu, Michael V. Rocco, Robert Toto, Timothy E. Craven, Tom Greene, Udayan Bhatt, Alfred K. Cheung, Debbie Cohen, Barry I. Freedman, Amret T. Hawfield, Anthony A. Killeen, Paul L. Kimmel, James Lash, Vasilios Papademetriou, Mahboob Rahman, Anjay Rastogi, Karen Servilla, Raymond R. Townsend, Barry Wall, Paul K. Whelton
Institutions: Tulane University, University of Minnesota, University of California, Los Angeles, University of Utah, University of Illinois Chicago, Memphis VA Medical Center, National Institute of Diabetes and Digestive and Kidney Diseases, Raymond G. Murphy VA Medical Center, Washington DC VA Medical Center, Wake Forest University Health Sciences, Wake Forest University, The Ohio State University, Case Western Reserve University, University of Pennsylvania, The University of Texas Southwestern Medical Center
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: GlaxoSmithKline, Omeros Corporation, National Institutes of Health, Sanofi Genzyme, National Heart, Lung, and Blood Institute, National Institute of General Medical Sciences, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Research Resources, National Center for Advancing Translational Sciences
Awards: SPRINT - Factors Affecting Atherosclerosis Study (FAST), Stanford Center for Clinical and Translational Education and Research (SCCTER)UL1, G1201304535, G130883262, G1346455397, G1452718737, G1534123016, G1575401839, G1638468373, G1815451664, G2301334622, The Ohio State University Center for Clinical and Translational Science (UL1), G2573152475, Tufts Clinical and Translational Research Institute, G3042542605, G3658248675, Translational Research in Hypertension and Renal Biology, UC Davis Clinical and Translational Science Center, G3759862710, G397302370, Clinical and Translational Science Institute at Children's National, UF Clinical and Translational Science Award, G4245472998, G4564909125, G468806925, G5068655555, G522538789, G576625284, G5831220822, Tufts Clinical and Translation Science Institute (UL1), G5971433106, G6948654770, G7041822434, G742032275, Institutional Clinical and Translational Science Award, The Vanderbilt Institute for Clinical and Translational Research (VICTR), General Clinical Research Center, Clinical and Translational Science Collaborative of Cleveland, G847355820, G8723760441, G884570035
OpenAlex ID: W2754728199