Y Obi1,2, K Kalantar-Zadeh1,3,4, A Shintani5, C P Kovesdy6,7, T Hamano8. 1. Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA. 2. Dialysis Unit, Obi Clinic, Osaka, Osaka, Japan. 3. Fielding School of Public Health at UCLA, Los Angeles, CA, USA. 4. Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA. 5. Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Osaka, Japan. 6. Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA. 7. Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA. 8. Department of Comprehensive Kidney Disease Research, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
Abstract
BACKGROUND: The Systolic Blood Pressure Intervention Trial (SPRINT; ClinicalTrials.gov, NCT01206062) reported reduced cardiovascular events by intensive blood pressure (BP) control amongst hypertensive patients without diabetes. However, the risk-benefit profile of intensive BP control may differ across estimated glomerular filtration rate (eGFR) levels. METHODS: This is a post hoc analysis of the SPRINT. Nondiabetic hypertensive adults (n = 9361) with eGFR >20 mL per min per 1.73 m2 were enrolled from 102 US facilities between November 2010 and March 2013 and were followed up until August 2015 (median follow-up, 3.26 years). Patients were randomly assigned to either a systolic BP target of <120 or <140 mmHg (for intensive or standard treatment, respectively). The outcomes of interests were the development of (i) fatal and nonfatal major cardiovascular events and (ii) acute kidney injury (AKI). RESULTS: The cardiovascular benefit from intensive treatment was attenuated with lower eGFR (Pinteraction = 0.019), whereas eGFR did not modify the adverse effect on AKI (Pinteraction = 0.179). Amongst 891 participants with eGFR <45 mL per min per 1.73 m2 , intensive treatment did not reduce the cardiovascular outcome (54/446 vs. 54/445 events in the standard group, respectively; hazard ratio [HR], 0.92; 95% CI, 0.62-1.38) with an absolute rate difference (ARD) of -0.02 (95% CI, -0.07 to +0.03) per 100 patient-years, whereas it increased AKI (62/446 vs. 38/445 events in the standard group; HR, 1.73; 95% CI, 1.12-2.66) with an ARD of +1.93 (95% CI, +1.88 to +1.97) per 100 patient-years. CONCLUSIONS: Intensive BP control may provide little or no benefit and even be harmful for patients with moderate-to-advanced chronic kidney disease.
RCT Entities:
BACKGROUND: The Systolic Blood Pressure Intervention Trial (SPRINT; ClinicalTrials.gov, NCT01206062) reported reduced cardiovascular events by intensive blood pressure (BP) control amongst hypertensivepatients without diabetes. However, the risk-benefit profile of intensive BP control may differ across estimated glomerular filtration rate (eGFR) levels. METHODS: This is a post hoc analysis of the SPRINT. Nondiabetic hypertensive adults (n = 9361) with eGFR >20 mL per min per 1.73 m2 were enrolled from 102 US facilities between November 2010 and March 2013 and were followed up until August 2015 (median follow-up, 3.26 years). Patients were randomly assigned to either a systolic BP target of <120 or <140 mmHg (for intensive or standard treatment, respectively). The outcomes of interests were the development of (i) fatal and nonfatal major cardiovascular events and (ii) acute kidney injury (AKI). RESULTS: The cardiovascular benefit from intensive treatment was attenuated with lower eGFR (Pinteraction = 0.019), whereas eGFR did not modify the adverse effect on AKI (Pinteraction = 0.179). Amongst 891 participants with eGFR <45 mL per min per 1.73 m2 , intensive treatment did not reduce the cardiovascular outcome (54/446 vs. 54/445 events in the standard group, respectively; hazard ratio [HR], 0.92; 95% CI, 0.62-1.38) with an absolute rate difference (ARD) of -0.02 (95% CI, -0.07 to +0.03) per 100 patient-years, whereas it increased AKI (62/446 vs. 38/445 events in the standard group; HR, 1.73; 95% CI, 1.12-2.66) with an ARD of +1.93 (95% CI, +1.88 to +1.97) per 100 patient-years. CONCLUSIONS: Intensive BP control may provide little or no benefit and even be harmful for patients with moderate-to-advanced chronic kidney disease.
Authors: Charles Ginsberg; Timothy E Craven; Michel B Chonchol; Alfred K Cheung; Mark J Sarnak; Walter T Ambrosius; Anthony A Killeen; Kalani L Raphael; Udayan Y Bhatt; Jing Chen; Glenn M Chertow; Barry I Freedman; Suzanne Oparil; Vasilios Papademetriou; Barry M Wall; Clinton B Wright; Joachim H Ix; Michael G Shlipak Journal: Clin J Am Soc Nephrol Date: 2018-11-13 Impact factor: 8.237